Job Description

Posting number: 26-00562

Department: Human Services

Job classification: DHS-Fraud Investigator

Posting type: Open

Categories: Investigative

Summary

The Fraud Investigator examines public assistance fraud, conducts fraud prevention activities, and performs benefit recovery activities for overpayment claims for the multi-county Great Rivers Consortium (GRC). This position documents and reports activities in compliance with laws and regulations.

Examples of duties

• Demonstrates effective motivational leadership techniques to act as investigator to the Great Rivers Income Maintenance Consortium; transfers expertise in investigative techniques and methods to provide direction for the course of field investigations; maintains electronic and written files on the progress and status of field investigations in adherence to legal requirements; provides fraud prevention training for consortium staff in order to make full use of individual capabilities and to meet changing system demands; monitors achievement of outcome-based performance measures to maintain quality of service.
• Illustrates knowledge of current laws and regulations pertaining to economic support programs and eligibility factors to examine and report potential fraud, waste, and abuse as well as complaints and concerns regarding publicly funded and supported services; receives, records, and assesses the legitimacy of complaints and referrals of suspected fraud for economic support programs; conducts intensive investigative interviews to determine whether or not fraud was intentionally committed; obtains and verifies third-party information; collaborates with various agencies and support services; maintains strict confidentiality on all contacts made and information gathered.
• Prepares and maintains detailed and concise records and reports in compliance with legal record keeping and reporting requirements; compiles information and prepares written reports on information gathered for the District Attorney's office; records and documents all Front-End Verification (FEV) and fraud investigation referrals and actions taken; determines, conducts, documents, and reports appropriate verification actions.
• Provides effective and credible testimony in court or administrative hearings regarding clients’ allegedly fraudulent activities, investigations, and findings.
• Conducts special case audits on targeted areas, particularly error prone cases; exercises judgement to determine outcome and provide recommendations based on results.
• Establishes and maintains professional working relationships with local and state agencies, law enforcement, employers, and the general public.
• Performs other related duties as required or assigned.

Qualifications

• Associate degree in criminal justice, human services, or a related field; or an equivalent combination of education, training, and relevant investigative experience.
• Two (2) years of experience conducting investigations, including investigative interviewing, gathering and evaluating evidence or information, and preparing investigative reports. Experience may include criminal, civil, administrative, fraud, compliance, public assistance, or other related investigations.
• Proficiency using computers and electronic systems for documentation, research, communication, and report preparation.
• Appointment will be conditional upon successful completion of criminal and caregiver background checks.
• Must maintain a valid driver’s license and automobile liability insurance meeting or exceeding Wisconsin’s minimum coverage requirements, with proof of insurance provided upon hire and maintained throughout employment.
• This position will work remotely travel within the ten-county consortium region.
• An ergonomically correct and confidential workspace, at own expense, is required for this position when working remotely.
• Employees must provide high speed internet access at own expense when working remotely.
• Must be a Wisconsin resident.

Supplemental information

• Experience working with Client Assistance for Reemployment and Economic Support (CARES), Forward Health, State of Wisconsin Kids Information Data System (KIDS), Child Care Statewide Administration on the Web (CSAW), Benefit Recovery Investigation Tracking System (BRITS) and/or ebtEDGE.
• Experience interpreting and applying public assistance policies and procedures related to Medicaid, FoodShare, and Child Care benefits.