Job Description

Fraud Investigator

  • 517140
  • Full-time


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

The Office of Inspector General

Job Location:

Address:  801 E. Jefferson Street, Phoenix, AZ 85034 / 7202 E. Rosewood #210, Tucson, AZ 85710

Posting Details:

Open until filled: 1st review of resumes is on 4/28/2023

Salary: 42,000 - 46,000 

Grade: 19

Must reside in the State of Arizona.

This position may offer the ability to work remotely based upon the departments needs

and continual meeting of expected performance measures.   

Job Summary:

The Office of Inspector General is looking for a highly motivated individual to join our team as a Fraud Investigator. This position is responsible for conducting 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 and will participate as a witness in the DES grievance process when an investigation was conducted, applicant was ineligible, case denied, and the applicant filed an appeal.
* Planning, scheduling, prioritizing work activity; set up workload controls, determine priorities, 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):

* 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)
* 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

* Analyzing case records, evaluation and interpretation of written and verbal information, troubleshooting and problem solving
* Research methodologies, independent working skills (requiring a minimum of supervision)
* Interviewing techniques to elicit information
* Verbal and written communication, basic computer skills Interpersonal relations as applied to contact with benefit recipients, landlords, employers, public and private organization representatives

* 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
* Successfully work and be productive in a virtual environment


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

* Bilingual (Spanish) is a plus.
* Experience in the rules regarding the admissibility of statement, and confessions; Title 19 and ASRS title 13 & 16
* Bachelor Degree in accounting or close related fields.

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 may be 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.


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 (13 and 12 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

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


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
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

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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