Medicaid Fraud Investigator/Special Agent

Full Job Description

The Consumer Protection Section is seeking an experienced investigator to join the Colorado Medicaid Fraud, Abuse & Neglect Unit (“MFANU”). The MFANU’s mission is to hold providers accountable for Medicaid fraud and patient abuse across the state of Colorado. This position is ideal for someone with experience investigating criminal and civil cases who seeks to make a difference for Colorado’s most vulnerable populations.


WHO WE ARE
The Office of the Attorney General/Department of Law is the "People's Lawyer". The Attorney General, Phil Weiser, was elected by the people of Colorado and is the State's chief lawyer and law enforcement official. Our vision for the Department of Law is: "Together, we serve Colorado and its people, advancing the rule of law, protecting our democracy and promoting justice for all." Our core values and commitment to diversity, equity, and inclusion, drive our actions and demonstrate our focus on being principled public servants who are innovative and better together.

Visit our website to learn more: https://coag.gov/.

Requirements

WHAT YOU WILL DO

The dual missions of the MFANU are:

• To protect the state and federal funds dedicated to providing health care and medical services to Colorado Medicaid beneficiaries.
• To hold individuals accountable for the abuse, neglect, or financial exploitation of clients in board and care facilities as well as those in facilities that accept Medicaid dollars.

This unit evaluates referrals to determine if they warrant further investigation and criminal prosecution or civil filing in state or federal court. The unit often partners with local and federal law enforcement and regulatory agencies to pursue justice for vulnerable Coloradans.

The Investigator position will work both independently and as part of a multidisciplinary team to conduct civil and criminal investigations, litigation, and prosecution of fraudulent activity by Medicaid providers (such as hospitals, doctors, pharmacies, nursing homes, etc.) and of patient abuse (such as physical assault, sexual assault, homicide and embezzlement of patient trust funds). This position may also be assigned to civil investigations in support of the Colorado False Claims Act. Additionally, the incumbent will provide technical training, advice and assistance to other law enforcement agencies in various jurisdictions across Colorado in the investigation of such matters.


This recruitment may also be used to fill other Special Agent positions in the Consumer Protection section.

Qualifications

WHAT WE ARE LOOKING FOR

Minimum Qualifications: Please document all relevant experience in detail on your application. Experience will not be inferred or assumed. Any part-time experience listed will be prorated.

• Six years of professional investigative experience as a sworn detective or criminal investigator at the felony level for a government law enforcement agency.

OR

A combination of directly related education (such as Criminal Justice, Psychology, or Sociology) and professional investigative experience as a sworn detective or criminal investigator at the felony level for a government law enforcement agency equal to six (6) years.

Experience must include filing felony level criminal cases in a criminal court as the lead investigator.

Required Competencies: The following knowledge, skills, and abilities are required for this position and will be considered during the selection process, including examination and/ or interview:

• Demonstrated organizational skills, including the ability to multi-task, prioritize tasks, and meet deadlines;
• Demonstrated work experience managing or leading large-scale or complex investigations;
• Strong oral and written communication skills, including the ability to communicate concisely and effectively;
• Customer service and interpersonal skills, including the ability to work on a team;
• Strong critical thinking and analytical skills.

Preferred Qualifications: In addition to the minimum qualifications, if you possess any of the following specifically include the details on your application, as this information will be used to assess your qualifications and may be used to determine a top group of applicants.

• Experience investigating and researching matters involving violations of State and Federal regulations;
• Work experience with Medicaid or Medicare regulations and statutes;
• Experience investigating document intensive white collar fraud cases from intake to completion;
• Experience working with medical records and bank records during the course of an investigation;
• Work experience with database programs, such as Excel or Access, used to analyze data and track evidence;
• Proficiency in Spanish, Chinese, German, Vietnamese, or another commonly spoken language in Colorado;
• Training as a forensic interviewer;
• Experience in planning tactical operations;
• Experience working with multidisciplinary investigation and prosecution teams, including with state or federal agency partners;
• Experience conducting public outreach;
• Certified Fraud Examiner;
• Experience/training as a FTO or as a LE instructor;
• Participation with health care fraud or elder abuse task forces or committees;
• Experience investigating cases involving vulnerable populations, including working cases involving victims/witnesses with developmental or intellectual disabilities.
• Experience working in a fast-paced environment that involves managing an active caseload.

Conditions of Employment:

Candidates must be Colorado P.O.S.T. certified at the time of hire. In accordance with C.R.S. §24-31-303 (5)(a) and (b), applicants must be Colorado P.O.S.T.

certified, including the requirement of completing a physical and psychological evaluation (if it has been more than three years since a physical and psychological evaluation has been conducted).

Following a conditional job offer, but prior to appointment, a candidate not meeting the requirement of C.R.S.

§24-31-303(5)(b) will be subject to a physical and psychological evaluation to determine fitness to serve as a peace officer. Must be proficient with a handgun.

Must be available, sometimes on short notice, to travel within and outside the State of Colorado.

Must be available to work nights and/or weekends when necessary to conduct fast-paced investigations, execute search warrants, or prepare for trial.

Applicants must pass a thorough criminal and personal background check, including a review of the personnel file from prior employment.

Position may be required to work outside of regular business hours, including possible early mornings, evenings, weekend, and overnight assignments. This is not an on-call position. Position must have a valid CO driver's license.

This position may be eligible for flexible work arrangements, including a hybrid work schedule after an initial training period.

Colorado Department of Law participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

HOW TO APPLY
Required Application Materials: Applicants may redact information that identifies their age, date of birth, or dates of attendance at or graduation from an educational institution.

1. A completed State of Colorado Application: Applicants are responsible for ensuring that the application provided is fully completed and clearly describes their education, training and experience as it relates to this position. Applications left blank or marked “See Resume” will not be considered.
2. Writing Sample: As part of your application, please attach a writing sample. We strongly prefer an affidavit. If you do not attach this writing sample, your application will be removed from consideration.

Veteran’s Preference: In order to be considered for veteran’s preference you must attach a copy of your DD214 forms as well as any documentation required to prove disability or marital status.

FOR CURRENT OR FORMER EMPLOYEES OF THE STATE OF COLORADO:
All current and former State employees must ensure that your entire work history within the State Classified System, including at Institutions of Higher Education, is indicated in your application so that your time-in-series can be calculated accurately.

Your application will be reviewed by a qualified Human Resources Specialist to determine if you meet the minimum qualifications for this position. If your application does not demonstrate that you meet the minimum requirements, you will be notified that you will not proceed in the selection process for this position. If your application is rejected and you have questions, you may contact Mercedes Chansisourath at 720-508-6793 or mercedes.chansisourath@coag.gov.

Assessment Information:
Colorado Revised Statutes require that all state employees be hired and promoted through comparative analysis of merit and fitness. Upon meeting the minimum qualifications, the next phase of the process is typically a structured application/resume review by a panel of subject matter experts against the job duties and/or preferred qualifications in this job announcement to determine technical competence, depth and breadth of experience and potential job fit.

• Technical Competence – Technical experience as it relates to the duties outlined in this job announcement.
• Depth and Breadth of Experience – Experience that covers multiple areas outlined in this job announcement and demonstrates the level of responsibility assigned.
• Job Fit – Experience will be evaluated to determine how well experience aligns with and meets the business needs of this position. Current experience is preferred.

It is imperative that the “Work Experience” section of your application is complete and specifically addresses your qualifications, experience, work product, and accomplishments as they relate to the Description of the Job, Minimum Qualifications, and Preferred Qualifications as listed above. Failure to include adequate information or follow instructions by the closing date may result in your application not being accepted and/or may affect your inclusion in the final pool of eligible applicants as the materials may be used to identify a top group for additional assessment or establish an eligible list for referral to the hiring manager for final consideration.

Appeal Rights: If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.

An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email, US Mail, faxed or hand delivered within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.

For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board go to spb.colorado.gov or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.

Additional Information

WHY WORK FOR US

We Embrace Flexibility
We aim to produce outstanding work product for all of our customers

We Are Committed to Diversity, Equity and Inclusion
At the DOL, our commitment to DEI is thriving. We know that we are better together when our differences are valued and everyone is inspired and empowered to contribute. As such, we strive to provide a safe environment where individuals feel valued and respected for who they are; demonstrate a behavior and mindset where differences are welcomed, and individuals are treated equally and empowered to do their best work; and promote growth and innovation through a diverse workforce. We empower an active Diversity Equity & Inclusion Impact Team that creates approaches to ensure safe spaces and a culture supportive of people being their authentic selves, hosts events and programs on DEI areas important to our employees, enables development and sustainability of resource groups that give a voice to historically marginalized populations, focuses on retaining our incredible talent, and more! If your professional goals include promoting growth and innovation with colleagues who recognize that we are better together when our differences are valued and respected, then DOL is your place to be!

We Have Strong Core Values
Our core values drive our actions. At the Department of Law, we are: 1) principled, maintaining the highest ethical standards, rigorous legal analysis, and careful evaluation of facts; 2) public servants, who are always ensuring our work is not about us, but instead is about the people of Colorado; 3) innovative, by seeking to identify the best approach, make deliberate decisions, and look to improve; and 4) "better together," by working to support each other and collaborate.

We are Committed to Developing our Employees
We are deeply invested in our talent and regularly provide meaningful opportunities for personal and professional growth through training and coaching. Further, our professional development and performance goal setting process is collaborative and ongoing, and aimed at helping our employees grow and succeed.

We Offer Excellent Benefits
In addition to the comprehensive State of Colorado benefits package including competitive medical and dental health plans, employer-paid life insurance, paid holidays, retirement plans with Colorado PERA, and vacation and sick leave earned each month, there are many other unique benefits that we offer, including:

• Medical and dental health plans
• Employer-paid life insurance
• Paid vacation and sick leave earned each month
• 10 paid holidays per year
• Public Service Loan Forgiveness – A borrower may qualify for forgiveness by making 120 on-time payments while employed full-time in public service, if they have certain kinds of federal loans in a qualifying repayment plan
• Free access to an on-site fitness center
• Strong, flexible retirement benefits including 401K and 457 plans
• Distinctive career advancement opportunities throughout the State personnel system
• Excellent work-life programs, such as flexible work schedules, professional development opportunities, and an employee discount program
• We value quality of life for our employees, and do not require on-call or shift work for this position.

To learn more about our benefits visit: https://www.colorado.gov/dhr/benefits.

The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

The Department of Law is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Julie Christopher, at Julie.Christopher@coag.gov or call 720-508-6511 .

If you have any questions regarding this position, please contact HR Specialist Mercedes Chansisourath at mercedes.chansisourath@coag.gov