Lead Investigator

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

JOB DESCRIPTION

The Office of Inspector General (OIG) Benefits Program Integrity (BPI) Field Investigator VII reports to the BPI leadership team. This position conducts complex administrative and criminal fraud investigations statewide involving HHS programmatic services, such as Medicaid; the Children’s Health Insurance Program (CHIP); the Supplemental Nutrition Assistance Program (SNAP); Temporary Assistance for Needy Families (TANF); and the Women, Infants, and Children’s (WIC) program. The Investigator VII performs highly complex consultative and technical work in planning, developing, implementing, monitoring, and instructing BPI Investigators in all aspects of investigative work. The position serves as a subject matter expert on program laws, regulations, and requirements; agency policies, procedures, and systems; and investigative standards, principles, evidentiary guidelines, and case preparation and presentation. The Investigator VII is also responsible for developing strong relationships with external partners, including local District Attorneys’ Offices; coordinating responses to legislative and other governmental inquiries; and assisting with special projects. The position will require extensive field work, evidence gathering, and testimony at both HHS administrative hearings and criminal proceedings. This position will focus on identifying and investigating criminals and criminal organizations targeting HHS benefit programs for financial gain. The selected applicant may be assigned to local, state or federal tasks force.

The position assists the BPI leadership team with prioritizing unit schedules, workload and assignments, and meeting established deadlines for projects. The position prepares and presents training; reviews and/or develops investigative techniques; assists with development of policies and procedures for conducting investigations; recommends improvements, changes, or modifications to BPI processes to increase efficiency and effectiveness of division activities and promote program integrity; coordinates the collection and analysis of evidence and data obtained through field investigations; collaborates with other team leads and managers across the state to promote consistency; may serve as a division liaison on special projects and cross-divisional workgroups; and performs other duties as assigned and required to meet the mission and goals of the department. Works under minimal supervision with extensive latitude for the use of initiative and independent judgment.

ESSENTIAL JOB FUNCTIONS

25% Researches, collects evidence, reviews records, and examines potential criminally prosecutable allegations through multiple agency, state, and federal systems to determine program compliance and identify fraud. Interacts and exchanges information with various internal and external stakeholders; coordinates with law enforcement organizations and other state and federal agencies; conducts subject, witness, and collateral interviews regarding suspected violators to meet stringent evidentiary standards; completes other evidence-gathering techniques as necessary to substantiate fraud; and coordinates complex investigations.

25% Coordinates, evaluates, summarizes, and documents investigative findings. Prepares records, correspondence, and complex investigative reports. Examines, investigates, and analyzes the client’s activities to ensure compliance with statutory standards and regulations. Reviews and researches the legal aspects of investigations and recommends action as appropriate. Provides information for subpoena drafting and serving. Prepares cases for presentation at hearing or in court. Testifies and presents evidence in formal hearings and court proceedings.

15% Calculates overpayments across multiple programs with differing and intricate requirements that vary depending upon the services and circumstances of a particular case. Establishes intentional program violation overpayment claims. Tracks adjudication and disposition actions, initiates restitution collection, and coordinates disqualifications, as applicable. 

10% Maintains clear and thorough investigative documentation and implements well-organized electronic filing and documentation systems. Employs organizational techniques to manage a high volume of investigations at various stages simultaneously, including planning travel and coordinating field activities. Responds to inquiries, callbacks, and correspondence from principles and collaterals involved in an investigation, providing accurate and clear information and employing investigative interviewing techniques to obtain information relevant to the investigation. 

10% Planning, developing, implementing, monitoring, and training unit investigators in all aspects of HHS programs. Identifying trends, problems, or issues and suggesting and establishing solutions. Collaborates with BPI Research, Analysis, Policy, and Training team to recommend and develop improvements to BPI policies, procedures, and training.

10% Coordinates with BPI leadership to recommend and implement process improvements that increase efficiency and effectiveness of investigative activities and documentation. Adheres to confidentiality requirements and records retention schedules. May review samples of completed investigations to ensure the use of consistent and correct application of policy and promote quality. May monitor and report on investigative trends and statistics. May prepare and deliver training, assist with policy and procedure or job aid development and review, and provide input into and assist in testing automated system enhancements or fixes.

5% Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.  Keeps leadership informed as required or as necessary.

KNOWLEDGE, SKILLS, AND ABILITIES

•       Knowledge of office management and HHS administrative procedures.

•        Knowledge of investigative principles, techniques, and procedures.

•        Knowledge of administrative hearing and court procedures, practices, and rules of evidence.

•        Knowledge of state and federal laws, regulations, and policies related to health and human services.

•        Knowledge of HHS social services programs and eligibility requirements.

•        Knowledge of agency and community resources.

•        Experience in applying HHS social services program eligibility requirements to recipient investigations.

•        Experience in using automated systems for documentation, research, and tracking.

•        Skill in communicating effectively both orally and in writing.

•        Skill in conducting investigative interviews and interrogations, both remotely and in person.

•        Skill in conducting legal research and analysis.

•        Skill in the use of computer/laptop equipment and applicable software applications.

•        Skill in using the Automated System for the Office of Inspector General (ASOIG).

•        Skill in finding applicable resources across agency systems.

•        Skill in performing sophisticated budget calculations and using mathematical formulas.

•        Skill in handling multiple competing priorities and meeting deadlines.

•        Skill in using Excel and other Office Suite software applications to analyze data and produce complex reports.

•        Ability to establish and maintain effective working relationships with others.

•        Ability to organize research and gather evidence.

•        Ability to interpret and apply laws and regulations.

•        Ability to plan, organize, and conduct multiple complex investigations simultaneously.

•        Ability to apply agency policies and guidelines and determine employee or recipient compliance.

•        Ability to compile, evaluate findings, and present information relevant to investigations.

•        Ability to use facts to prepare high-quality investigative reports for administrative hearings and criminal prosecution with strong attention to detail that clearly demonstrate how the evidence gathered proves that fraud occurred.

•        Ability to provide factual and convincing testimony in hearings or court proceedings.

•        Ability to conduct diverse investigations with minimal supervision.

•        Ability to lead a team of other investigators.

•        Ability to organize workloads and set priorities.

•        Ability to develop training materials and instruct and train others.

REGISTRATION OR LICENSURE REQUIREMENTS

Current, Valid Driver’s License Required

INITIAL SELECTION CRITERIA

Graduation from an accredited high school or GED. Graduation from an accredited four-year college or university with major coursework in business, public administration, criminal justice, or a field related to the assignment. Two years’ experience conducting criminal investigations. Two years’ experience conducting OIG beneficiary investigations involving SNAP, TANF, and/or Medicaid policies, procedures, and regulations is preferred.

ADDITIONAL INFORMATION

This position requires 75% travel.      

The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing and investigating fraud, waste and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint-based criminal background check through the Texas Department of Public Safety (TDPS) and Federal Bureau of Investigations (FBI) to determine if they have criminal history record information that constitutes a bar to employment.

The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the AccessHR service center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.

Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.