Job Description

Fraud Investigator

  • 508967
  • PHOENIX
  • REMOTE OPTIONS
  • TUCSON
  • AHCCCS
  • Full-time

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Fraud Investigator

Office of Inspector General

Job Details:

Address: 7202 E. Rosewood #210, Tucson AZ 85710

Open until filled: 1st review of resumes on date 7/1/22

Salary: $44,000 - $47,300 

Grade: 19

This position is eligible for part-time/full-time remote work (including virtual office arrangement). Must reside in the State of Arizona.

Job Summary:

The Office of Inspector General is looking for a highly motivated individual to join our team as a Fraud Investigator. This position conducts field investigations to evaluate the accuracy of eligibility determinations for state and federal programs to prevent ineligible applicants from being approved. Major duties and responsibilities include but are not limited to:

* Traveling, Interviewing, gathering data and developing sources of information

* Review and assess information in the case record; analyze data obtained from all sources, case development, assessing the accuracy of the application, determining expenditures for cost benefit analysis and writing investigative summaries.

* Planning, scheduling, prioritizing work activity; set up workload controls, determine priorities, and monitor activity progress, set goals.

* Studying statutes, rules, policy manual and clarifications, attending training and conferring with supervisor and others to improve skills and maintain expert level of knowledge.

* Participate in special projects that may include out of town travel involving residency/eligibility checks of participants as well and on-site audits of certain high risk Medicaid providers.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
* Claims reporting activity, Microsoft Windows software, Excel spreadsheet software, basic understanding of data base software, Medicaid Programs and Prepaid Medical Management Information System (PMMIS) and/or DES Eligibility System (AZTECS)

* Expert knowledge of State statute, rules and regulation relating to the determination of eligibility for AHCCCS programs, legal and technical terminology for the interpretation of highly diverse forms of verification including, but not limited to, divorce decrees, county property assessment records, medical records, hospital billings, life insurance policies, public assistance benefits and self-employment records.

Skills:
* Analyzing case records, evaluation and interpretation of written and verbal information, troubleshooting and problem solving skills, research methodologies, independent working skills (requiring a minimum of supervision), interviewing techniques to elicit information, effective verbal and written communication, basic computer skills, interpersonal relations as applied to contact with benefit recipients, landlords, employers, public and private organization representatives, the use of tactful diplomacy due to the political nature of the job.

Abilities:
* Work within a team environment, function effectively in an orderly and purposeful manner in situations of stress or tension, work with the public in less than ideal conditions, deal with multiple tasks at one time, be successful and productive in a virtual office environment.

Qualifications:

Minimum:
*  Experience in auditing work, principles, standards and technique.

Preference:
* Experience of the rules regarding the admissibility of statement, and Confessions Title 19 and ASRS title 13 & 16.

* Bilingual (Spanish) is a plus

Pre-Employment Requirements:

* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
* Travel is required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

Benefits:

Among the many benefits of a career with the State of Arizona, there are:
*  10 paid holidays per year
*  Paid Vacation and Sick time off (12 and 13 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
*  A top-ranked retirement program with lifetime pension benefits
*  A robust and affordable insurance plan, including medical, dental, life, and disability insurance
*  Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
*  RideShare and Public Transit Subsidy
*  A variety of learning and career development opportunities
*  Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)

By providing the option of a full-time or part-time virtual/remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

Lifetime Pension Benefit Program
*  Administered through the Arizona State Retirement System (ASRS)
*  Defined benefit plan that provides for life-long income upon retirement.
*  Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
*  Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
*  Voluntary participation.
*  Program administered through Nationwide.
*  Tax-deferred retirement investments through payroll deductions.

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

Application Instructions

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