Investigator OR Senior Investigator / Human Services Program Representative 1 OR Human Services Program Representative 2

About the role

This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.

Responsibilities

• Review, investigate, and appropriately resolve all cases identified through data analysis, assigned by the Manager or Supervisor, or referred by providers, recipients, other Department of Human Services (DHS) units, state, local and federal agencies, other third-party payers and the general public.
• Consult with Program Analysts, other Investigators, or management to develop criteria and parameters to identify providers activity that can be compared to other providers in order to investigator or develop potential cases for investigation.
• Independently investigate and assist other investigative staff to initiate, develop, and resolve cases which lead to administrative actions, sanctions, referrals for criminal action, and/or monetary recoveries of county, state and federal funds erroneously or fraudulently received by providers of services to clients of Medical Assistance.
• Develop and implement strategies toward fraud detection, comprehensive investigations, and the development of cases that may involve civil, monetary, or criminal case actions.
• Plan, develop, and implement strategies that are designed to minimize the opportunities for program abuse.

Qualifications

• Human Services Program Representative 1: Two (2) years of professional experience in the delivery of review and submission of claims administered by the Minnesota Health Care Programs (MHCP) AND Experience must demonstrate the following: Review and interpret health care services and billing data to determine the relevancy and importance of documents. Develop report formats for monitoring provider billing practices and developing cases. Identified policy problem areas and suggest changes and remedies if necessary.
• Human Services Program Representative 2: Three (3) years of professional experience conducting regulatory investigations designed to detect, identify, correct and/or resolve instances of suspected fraud, waste, and abuse. AND Experience must demonstrate the following: Develop criteria, parameters, exceptions and limits which will be used to identify providers having unusual or suspect claims activity. Record and account for all investigative activities, conversations, research, and information given and received from the subject regarding the case. Determine which federal and/or state laws, regulations and/or policies affect the case or cases being reviewed for each identified problem area.

Benefits

The State of Minnesota offers a variety of benefits to its employees, including:

• Paid vacation and sick leave
• 12 paid holidays each year
• Low-cost medical, dental, vision, and prescription drug plans
• Fertility care, including IVF
• Dental and orthodontic care for adults and children
• 6 weeks paid leave for parents of newborn or newly adopted children
• Pension plan that provides income when you retire (after working at least three years)
• Employer paid life insurance to provide support for your family in the event of death
• Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
• Tax-free expense accounts for health, dental, and dependent care