Investigative Specialist 2 Medicaid

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 conduct and oversee investigations of providers alleged of committing fraud, waste, and abuse. The official workstation of this position will be in either the White Plains or Hauppauge Regional office, and the incumbent will have responsibility for supervising staff in both regional offices. The Investigative Specialist 2 Medicaid will report to an Investigative Specialist 4 Medicaid in the New York City office which may require travel to that office in addition to the regional office.

Specific duties of the position include, but are not limited to:

• Supervising investigative staff in the White Plains and Hauppauge regional offices and investigative operations primarily in the surrounding counties within the offices area of responsibility. Investigative responsibility may span beyond the region; statewide if necessary.
• Evaluating complaints of Medicaid fraud, waste, and abuse and assigning complaints for investigation.
• Conducting regular case reviews for all staff to ensure progress meets investigative metrics and appropriate actions are taken.
• Working a personal caseload including complex investigations.
• Drafting correspondence, reports, and notices for public issuance in connection with administrative actions seeking to recoup Medicaid overpayments and impose sanctions.
• Maintaining working relationships with the Special Investigative Units within Managed Care Organizations to discuss fraud trends and matters referred to OMIG.
• Testifying at administrative hearings as necessary.
• Ensuring recoupment of overpayments and/or sanctions when appropriate.

Minimum Qualifications

Preferred Qualifications:

Excellent verbal and written communication skills. Proficiency with Microsoft Office Suite with the ability to learn new data systems.

Minimum Qualifications:

One year of permanent service as an Investigative Specialist 1

OR

Seven years of experience in conducting field investigations preliminary to administrative actions, civil litigation, or criminal prosecution. This experience must include conducting interviews of witnesses and others; taking written statements and affidavits; collecting and analyzing physical and documentary evidence; preparing detailed written reports of investigative findings; and testifying in court or at formal hearings. One year of experience must have been at a supervisory level.

Substitutions: 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.

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 officer, parole officer, correction officer, guard, inspector, or experience in adoption and/or foster care placement.