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Job/Position DescriptionInvestigator VIIThe Investigator VII (Lead) position is housed within the Provider Field Investigations (PFI), Medicaid Program Integrity unit of the Investigations and Utilization Reviews (IandUR) division of the Office of Inspector General (OIG) and reports directly to a PFI Manager. Performs highly complex administrative investigations of Medicaid providers involving allegations of fraud, waste and/or abuse in the provision and delivery of all health and human services in the state. Enforces state law relating to these services. This role requires interviewing skills, extensive research and data analysis, and the development of complex investigative reports. Work involves up to 25% statewide travel, which includes some overnight travel. The Lead Investigator works under limited supervision as the primary delegate for the PFI Manager with considerable latitude for the use of initiative and independent judgment. Supervises and coordinates the work of others. Mentors and trains junior investigative staff.* As of the date of this job posting, PFI investigators currently serve on a 100% mobile work status, with the understanding that the classification of mobile work is subject to revert back to a traditional on-site work or telework environment based upon agency needs and/or upon employee performance at any time. See additional information section below for more information on mobile work requirements. * Essential Job Functions1. Researches, reviews, and investigates highly advanced complaints and cases alleging Medicaid provider fraud, waste, and/or abuse and recommending action(s) as appropriate. Interprets and applies applicable agency, state and federal policies, procedures, rules, and regulations. Performs timely investigative duties in conformity with PFI policies and procedures, including but not limited to case-specific deadlines assigned by management. Completes no fewer than three full-scale investigations per year. Gathers, analyzes, and interprets business, financial, and medical documentation. Conducts interviews with recipients, witnesses, providers, complainants, and providerand#146;s staff regarding investigations. (40%)2. Evaluates, summarizes, and communicates investigative findings through video/oral/written communications. Prepares detailed, comprehensive, and grammatically correct case summaries for each assigned case. Performs timely administrative duties associated with investigations in conformity with applicable PFI policies and procedures, including but not limited to investigative timelines. (10%)3. Develops comprehensive exhibits, including but not limited to a schedule of incorrect claims, to ensure effective case presentations in administrative hearing and court cases, when required. Testifies and presents evidence in informal reviews and judicial proceedings (before administrative, civil, and criminal courts) as needed. (10%)4. Effectively communicates findings to the PFI Manager, Deputy Inspector General for MPI, other HHSC staff, and external entities. Provides testimony and presents evidence in formal hearings and court proceedings; develops and presents criminal fraud cases to criminal prosecutors, when appropriate. (10%)5. Acts as the primary delegate for the PFI Manager. Plans, assigns, and supervises the work of others. Develops, coordinates, and oversees highly complex projects and initiatives. Mentors and trains junior investigators. Ensures junior staff comply with established policy, procedure, recognized guidel https://jobshrportal.hhsc.state.tx.us/ENG/CareerPortal/job_profile.cfm?szOrderID=618379 Copy the URL in the preceding sentence to an Internet Explorer browser to apply to the job directly through the Texas Health and Human Services Career Portal.