Investigative Specialist 1/Trainee 1/Trainee 2

The Division of Medicaid Investigations ensures the integrity of the Medicaid program by conducting investigations, recovering over payments, and implementing administrative sanctions against providers. The incumbent will aid in this endeavor using their expertise to assist in the investigation of providers for potential fraud. Duties of the position will include, but are not limited to:

• Investigating all allegations of Medicaid fraud, waste, and abuse.
• Conducting fieldwork, including surveillance and onsite inspections. Fieldwork includes traveling to all areas throughout New York State.
• Conducting interviews and taking statements.
• Operating various data systems; analyzing information and drawing appropriate conclusions. Obtaining sufficient information and documentation to support investigative findings.
• Drafting correspondence, reports, and notices for public issuance in connection with administrative actions seeking to recoup Medicaid overpayments and impose sanctions.
• Testifying at administrative hearings as necessary.
• Collaborating with other regulatory oversight agencies and law enforcement and conducting joint investigations as appropriate.
• Serving as liaison with Managed care Organizations and participating in regular meetings with their Special Investigation Unit representatives.

Minimum Qualifications

Appointment to the Trainee 1 level requires:

Four years of investigative experience OR an associate degree and two years of investigative experience OR a bachelor’s or higher degree.

Appointment to the G-18 level requires:

Six years of experience in a field investigative position conducting interviews of witnesses and others, taking written statements and affidavits, collecting and analyzing physical and documentary evidence, and preparing detailed written reports of investigative findings.

Non-Qualifying

Investigative Experience includes but may not be limited to: Experience in routine police patrol work, security guard or related security position, tax collector, collector of delinquent accounts, credit checker, legal assistant/attorney, hotel or store detective, loss prevention office, parole officer, correction officer, guard, inspector, or experience in adoption and/or foster care placement.

Substitutions for the full G-18 title: an associate degree in criminal justice or related field may substitute for two years of qualifying experience. A bachelor’s degree in criminal justice or a related field may substitute for four years of qualifying experience. Related fields include: law enforcement, police science, criminal justice administration, criminology, criminal investigation, police studies, public justice, forensic accounting, forensic psychology, forensic science, and economic crime management.

Preferred Qualifications:

Excellent verbal and written communication skills. Proficiency with Microsoft Office Suite and ability to learn new systems. Ability to analyze and apply data to investigations. Understanding of the Medicaid program.