Special Agent - Medicaid Fraud

State of Utah    Salt Lake County, UT
Job Description
The Utah Office of the Attorney General has an immediate opening for a Special Agent in its Medicaid Fraud division. An incumbent in this position conducts investigations into crimes involving fraud committed by providers to the Medicaid Program and the abuse and neglect of patients residing in a variety of board and care facilities. Incumbent works exclusively on matters pertaining to the Medicaid Fraud Control Unit under the supervision of the Medicaid Fraud Director. This is an entry level position until candidate completes probation.
The investigation of Medicaid Fraud requires specialized training; including knowledge of health care finance and billing procedures, and use of technology and data analysis to show patterns of fraudulent activity. Incumbent is an experienced investigator who can work independently or as a team member with limited supervision.
Incumbent must be a POST certified law enforcement officer with demonstrated ability to investigate complex fraud cases. Experience investigating financial crimes and other white collar crimes is preferred. A bachelors degree is required along with a minimum of five years experience as an investigator/detective.
This job description is meant to describe the general nature of the work being performed. It is not meant to be construed as an exhaustive list of all responsibilities, duties, and skills required of such personnel. All personnel may be required to perform duties outside their normal responsibilities from time to time as needed. Incumbent may be assigned in accordance with the needs of the office. Overtime work and working weekends and holidays may be required. Travel is required throughout the State.
Example of Duties:
  • Enforces laws, rules, and regulations.
  • Conducts investigations into allegations of a variety of inappropriate activities, rules infractions or illegal actions.
  • Ensures compliance with applicable federal and/or state laws, regulations, and/or agency rules, standards and guidelines, etc.
  • Receives, researches and responds to incoming questions or complaints; provides information, explains policy and procedures, and/or facilitates a resolution.
  • Maintains detailed inspection or investigation records, prepares reports, and attends to other related administrative requirements.
  • Acts as an expert witness. Gives testimony and /or recommendations in court cases and/or hearings.
  • Coordinates program activities, services, and/or program implementation with private providers, other governmental entities, program users, etc.

Typical Qualifications: (includes knowledge, skills, and abilities required upon entry into position and trainable after entry into position)
  • use logic to analyze or identify underlying principles, reasons, or facts associated with information or data to draw conclusions
  • use case management software systems
  • use computer relational database software
  • provide consultation and/or expert advice or testimony
  • deal with people in a manner which shows sensitivity, tact, and professionalism
  • agency, professional and/or industry standards and practices
  • interviewing techniques
  • investigative techniques and processes
  • civil and criminal justice laws
  • applicable laws, rules, regulations and/or policies and procedures
  • legal processes and procedures
  • speak clearly, concisely and effectively; listen to, and understand, information and ideas as presented verbally
  • organize information in a clear and concise manner
  • read, interpret and apply laws, rules, regulations, policies and/or procedures
  • compose and produce reports, documents and related material
  • communicate information and ideas clearly, and concisely, in writing; read and understand information presented in writing
  • develop and maintain applicable professional contacts, resources and /or networks
  • principles, theories, and practices of law enforcement
  • coordinate the activities or tasks of people, groups and/or organization(s)
  • agency and community resources and services

Supplemental Information:
  • Job requires POST certification; Peace Officer Standards Training in Utah.
  • Valid driver license required to drive a motor vehicle on a highway in this state per UCA53-3-202(1)(a).
  • Risks found in potentially dangerous or unusual environmental stress situations, e.g. working at great heights, working in extreme outdoor weather conditions, being subject to possible physical attack, etc.
  • The work requires considerable and strenuous physical exertion such as frequent climbing, lifting heavy objects over 50 pounds, crouching or crawling in restricted areas, defending oneself and/or others against physical attack.

Tue, 07 Jan 2020 02:04:14 GMT

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