Job Description

Posting number: 190960

Department: Department of Health and Human Services

Division: Program Integrity

Job classification: Investigator III

Posting type: Open

Categories: Administration, Redevelopment, Investigative, Paraprofessional, Miscellaneous, Human Services, Social Sciences

Are you the One? We are looking for an Investigator III who conducts investigations to ensure compliance with South Carolina Department of Health and Human Services (SCDHHS) policies, state statues, and regulations. Conducts routine to complex sensitive investigations of Medicaid providers and beneficiaries or any reported fraudulent violation of the Medicaid program.Works with various officials and agencies on the local, state, and federal levels concerning related investigations. Assists the Office of General Counsel in coordination of witness testimony as needed at administration hearings.

• Conduct confidential and comprehensive investigations on provider cases and complaints to ensure compliance with South Carolina Department of Health and Human Services (SCDHHS) policies, state statue, and regulations.
• Interviews Medicaid beneficiaries, providers, and/or other witnesses to gather facts relating to potential Medicaid fraud and abuse. Prepares onsite investigative report at time of onsite review. Prepares interview summaries of Medicaid beneficiaries when interviewed.
• Use Medicaid Management Information Systems (MMIS), Citizen Law Enforcement Analysis and Reporting (CLEAR), IFLOW, SAS Analytics, OnBase, and other investigative tools as necessary to aid in conducting research on providers.
• Perform case reviews and provider referrals. Give timely and proper disposition to assigned complaints.
• Ability to testify at administrative and court hearings resulting from provider investigations.

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

Examples of duties

A high school diploma and experience conducting investigations.

A bachelor's degree may substitute for the required work experience.

Additional Requirements:

• Occasional overnight travel.
• Requires holder to drive routinely.
• Sitting or standing for long periods of time.
• Lifting Requirements: 30 lbs.
• Valid driver’s license
• In-office Role

Qualifications

• Experience in Medicaid or Medicare fraud and waste investigations, healthcare fraud investigations, or in the Special Investigations Unit (SIU) of a managed care organization (MCO).
• Knowledge of the laws, rules, and regulations applicable to the job.
• Knowledge of investigative techniques, principles, and practices.
• Ability to evaluate evidence and conduct investigations.
• Ability to analyze facts and reach sound conclusions.
• Ability to present clear, concise, and comprehensive written and oral reports.
• Ability to establish and maintain effective working relationships with officials, attorneys, witnesses, and the general public.
• Ability to plan, organize and direct investigative programs.
• Ability to maintain confidentiality.

Supplemental information

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.