Medicaid Fraud Investigator

State of Oregon - Portland, OR3.9

Full-time
This recruitment has been extended - we now have 2 (two) positions to fill, and all applications are still under consideration!

Analytical. Resourceful. Knowledgeable in building a rock-solid criminal case. Does this sound like you?

If so, come join our Civil Enforcement Division, Medicaid Fraud Unit team in Portland as an Medicaid Fraud Investigator (Investigator 3)! We offer generous benefits for you and your family, great work-life balance, and a strong public service mission you can definitely get behind.

Apply now! If selected, you will work closely with Medicaid Fraud Unit Assistant Attorneys General and other legal professionals to investigate and prosecute billing fraud committed by Medicaid providers, and abuse and neglect of residents who live in Medicaid-funded facilities. These complex cases can take years to investigate, but bring millions of dollars back to the state Medicaid program. This is a non-sworn investigator position.

WHAT'S IN IT FOR YOU?

Permanent, full-time employment in beautiful Portland, Oregon.
Opportunity to expand your investigative skills in public service.
Job satisfaction as part of a team whose mission is to serve Oregon's public and government agencies.
Health, dental, and vision insurance benefits for you and your family.
Vacation, sick leave, paid holidays, and special days off.
A workplace where individual contribution matters and is recognized, where creativity and accomplishment are rewarded.
Advancement opportunity within DOJ and other State agencies.
An agency committed to equal opportunity and workforce diversity.
Representation and support by the Service Employees International Union (SEIU).

HELP US ACHIEVE OUR MISSION: The Mission of the Oregon Department of Justice is to serve state government and to support safe and healthy communities throughout Oregon by providing essential justice services. The Attorney General and our nine divisions are dedicated to:

Providing ethical, independent and high quality legal services to state government;
Safeguarding consumers from fraud and unfair business practices;
Fighting crime and helping crime victims;
Advocating for vulnerable children;
Supporting families through the collection of child support;
Enforcing environmental protections;
Defending the civil rights of all Oregonians;
Pursuing justice and upholding the rule of law.

The Oregon Department of Justice is an equal opportunity, affirmative action employer committed to work force diversity.
Duties & Responsibilities

Medicaid Fraud Investigator positions are non-sworn.

Primary duties and responsibilities include, but are not limited to:

Procure, analyze and interpret computerized data, financial records, billing records, medical records, social service records, legal documents and other material in the pursuit of evidence for Unit cases.
Research program rules.
Develop investigative plans (frequently requiring multi-agency collaboration).
Identify and interview suspects and witnesses (including but not limited to health care professionals, state and county workers and Medicaid recipients).
Draft interview and investigative reports and memos.
Ensure all physical and documentary evidence is obtained and secured in compliance with state and federal criminal procedural and evidentiary rules.
Perform complex criminal investigations into allegations of fraud committed by Medicaid providers and allegations of abuse and neglect in long term care facilities.
Prepare legally admissible charts/graphs.
Testify at trial and other hearings.

WORKING CONDITIONS: Daily exposure to office environment with noise from ringing telephones, printers, copiers, telephone conversations and other office equipment. Daily use of computers. Daily juggling of multiple tasks with varying and changing deadlines with limited general supervision. Occasional demands to work overtime, weekends and evenings. Frequent contact/interviews with uncooperative and potentially hostile witnesses/suspects. Frequent in-state driving/traveling for investigations, court dates, meetings and trainings. Occasional out-of-state travel related to investigations, meetings or training. Daily requirement to exercise discretion and confidentiality. Daily interaction with other professionals.

CONDUCT EXPECTATIONS: The role of the Oregon Department of Justice is to provide justice and uphold the rule of law. Employees of the Department are required to meet the highest standards of professional conduct and ethics while on the job, and also to maintain those same high standards when taking actions in their personal lives that could reflect on the Department.

Qualifications, Required & Requested Skills

MINIMUM QUALIFICATIONS:
Four years of recent (within last ten years) full-time investigative experience which included conducting fact finding; collecting and preserving evidence according to the rules of evidence; examining records; locating and interviewing witnesses to verify or disprove claims of suspected law violations; and writing investigation reports sufficient for use at administrative hearings or in court.

Examples of qualifying investigation experience are in areas such as law enforcement investigation, insurance investigation, investigative trial support, or financial fraud investigation.

College-level courses in Law Enforcement, Criminal Justice, Law, Accounting, or Auditing may be substituted on a year-for-year basis for up to one year of the required experience.

REQUESTED SKILLS AND COMPETENCIES:
Law enforcement experience that includes conducting formal criminal investigations.
Experience conducting Social Service Fraud investigations and/or abuse and neglect investigations involving elderly or dependent individuals.
Experience investigating complaints of financial abuse of elderly or dependent individuals.
Experience investigating white collar crimes.
Experience investigating fraud involving health care programs, such as Medicaid, Medicaid, or other private health insurance programs.

Additional Information

TO APPLY:
Follow the "Apply" link above and complete the Oregon Employment Application and "Supplemental Questions" section of this announcement. The "Work History" section must clearly describe how you meet the "Minimum Qualifications" listed above.
Attach a COVER LETTER which describes how your experience and skills have prepared you for this position. While it is not expected that each applicant will possess all of the "Requested Skills and Competencies" listed, applicants who do not attach the required cover letter will have their application removed from further consideration.

NOTE: As part of the candidate review process, qualified applicants may be required to review a 12 minute video "scenario" and then write, with a 30 minute time limit, a sample "Interview Report" based on the video. The "Interview Report" will be graded for content.

Complete Application

The application must include work experience that supports how you meet the minimum qualifications and requested skills. A resume (attached or text) will not replace the work experience section of the application.
Your application materials and any supplemental information may be reviewed and evaluated for presentation, content, clarity, grammar, spelling, and applicable knowledge and skill(s).
Additional applicant screening will depend on the number of qualified applications received. Screening may include skills testing, the results which may be used as part of the applicant evaluation process.
Candidates whose background most closely matches the qualifications and required/requested skills of this position will be invited to an interview.

For more information on Transcripts, Criminal Records Checks, Salary, Veteran's Preference, Special Accommodation, etc., please click on this link. (Download PDF reader)

This recruitment will be used to fill the current vacancy, and may be used to fill future vacancies.
Core benefitsMedical, vision and dental insurance Comprehensive medical, dental and vision plans for the employee and qualified family members $5,000 in employee basic life insuranceRetirement benefits
Membership in the Public Employees Retirement System (PERS)/Oregon Public Service Retirement Plan (OPSRP) Employer paid defined benefit and defined contribution programs**Effective November 1, 2016, SEIU represented employees who are Public Employee Retirement System (PERS) participating members will have their base salary increased by 6.95%. Upon becoming a PERS participating member, SEIU employees pay the employee 6% contribution to PERS.
Paid leaves and other benefits
Sick leave earned at the rate of 8 hours per a month with no maximum accumulation Vacation leave earned at a minimum rate of 8 hours per month with accrual rate increases at 5-year increments 24 hours personal leave earned each fiscal year Ten paid holidays a yearThe state also provides access to an innovative Employee Assistance Program that offers work-life counseling, along with homeowner, legal and family resources.

Optional benefits
Term life (employee, spouse or domestic partner, and dependents Long-term and short-term disability Accidental Death and Dismemberment Long-term care (self and eligible family members) Flexible spending accounts Option to enroll in the Oregon Savings Growth Plan, a deferred compensation program offering a wide variety of investment options.
The following information describes typical benefits available for employees. Actual benefits received may differ by position or branch of government or be prorated for other than full time work.