Sergeant - Medicaid Fraud Investigator
State of Texas
. The Sergeant position involves advanced criminal investigations of Medicaid provider fraud and nursing home related investigations for the Office of the Attorney General¿s Medicaid Fraud Control Unit (MFCU). Work involves conducting criminal investigations of violations of various state and federal statutes and prosecution assistance as needed. OAG employees enjoy excellent benefits along with tremendous opportunities to do important work and make a positive difference in the lives of all Texans. JOB POSTING NOTICE Applicants for this position should be prepared to pass a background investigation. Applicants will also be subject to a motor vehicle registration check. The MFCU works cases jointly with other law enforcement agencies including the FBI, U.S. Department of Health and Human Services - Inspector General and IRS. In certain cases, it is necessary for our staff to have a Top Secret security clearance in order to fully participate in joint investigations or in task force activities. Top Secret clearances are not required prior to employment but in certain cases may be required at a later date. Since most security clearance problems arise from criminal records or unresolved bad credit issues, full criminal and credit checks will be run on all applicants prior to employment. Education: Graduation from high school or equivalent Education: Sixty credit hours from an accredited college or university; may substitute an associate¿s or bachelor¿s degree from an accredited college or university; or full-time investigations; law enforcement; auditing; accounting; compliance monitoring in Medicaid, Medicare, health care insurance, or closely related experience for the required education on a year-for-year basis Experience: Four years full time criminal investigative experience as a licensed peace officer or comparable federal law enforcement officer TCOLE certification Knowledge of TCOLE training requirements and healthcare fraud investigation training needs Knowledge of Microsoft Office products (i.e. Word, Excel, PowerPoint, Outlook) Knowledge of criminal investigative principles, techniques, and methodologies Knowledge of management and administrative principles, techniques, and methodologies Knowledge of agency goals, objectives, rules, regulations, policies, and procedures Knowledge of state and federal statutes, rules, and regulations pertaining to law enforcement activities Knowledge of criminal and civil court proceedings and rules of evidence Skill in effective oral and written communication (Writing sample will be required at time of interview, if selected) Skill in researching and interpreting complex rules and regulations Skill in applying investigative techniques and procedures Skill in handling multiple tasks, prioritizing, and meeting deadlines Skill in exercising sound judgment and effective decision making Ability to develop and implement strategic plans and budgets Ability to use and care for firearms Ability to use intermediate impact weapons and Oleoresin Capsicum spray Ability to use physical tactics Ability to conduct complex criminal investigations of Medicaid provider fraud and nursing home related investigations Ability to interpret and apply applicable provisions of the Texas Penal Code, the Texas Code of Criminal Procedure, and federal statutes pertaining to investigations Ability to interpret and apply department policies and procedures Ability to plan, assign, and supervise the work of others Ability to handle stressful situations Ability to receive and respond positively to constructive feedback Ability to work cooperatively in a professional office environment Ability to provide excellent customer service Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG work space within OAG work location, and perform in-person work with coworkers (e.g., collaborating, training, mentoring) for the entirety of every work week (unless on approved leave) Ability to arrange for personal transportation for business-related travel, with reimbursement Ability to work more than 40 hours as needed and in compliance with FLSA Ability to lift and relocate 30 lbs. Ability to travel (including overnight travel) up to 20% Ability to achieve 64% or better of VO2 max on the 2000-meter row, or meet a minimum score of 64% on the 500-meter row test or 4-minute row test, utilizing a Concept 2 Rower Experience conducting white collar/economic crime investigations Experience investigating healthcare provider fraud and working with state and federal prosecutors in criminal matters Accomplished practitioner of the MFCU documentation and report writing system or a like system Knowledge of healthcare fraud statutes (state and federal) #J-18808-Ljbffr State of Texas
$45.5 per hour
CPC/CPMA required Nov 16th to Feb 8th might extend Fraud Waste Abuse exp Commercial Medicare/ Medicaid on site Bowie MD 3 days a week SQL exp Exp with Health... ...with product and data science teams to translate investigative judgment into refined detection rules Track...Suggested3 days per week$85k - $105k
...Healthcare Fraud Investigator CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in... ...to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data). - Communication skills: Ability to interact...SuggestedWork experience placementWork at officeLocal area$65k - $88.6k
...Become a part of our caring communityThe Fraud and Waste Professional is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving South Carolina's Medicaid Program.The Fraud and Waste Professional coordinates investigation...SuggestedFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday$3,000 - $4,999 per month
...HHS webpage . Functional Title: Claims Investigator Job Title: Investigator II Agency: Health... ...recipients of HHS programmatic services, such as Medicaid; the Children’s Health Insurance Program... ...for investigating referrals of fraud, waste, and abuse by HHS clients; conducting...SuggestedFull timeTemporary workPart timeWork at officeRemote workShift work$55.6k - $79.4k
...we're looking for ~3+ years of experience detecting and investigating healthcare fraud ~2+ years providing excellent customer service and... ...Qualifications Certified Fraud Examiner (CFE) Experience with Medicaid Management Information Systems (MMIS) What you should...SuggestedFull timeRemote workFlexible hours- Health & Human Services Commission (HHSC) in El Paso, TX seeks an Investigator II for the Benefits Program Integrity unit. You will conduct moderately complex investigations into recipients of Medicaid, CHIP, SNAP, TANF, and WIC, gathering evidence, reviewing records, and...
$32.03 - $45.7 per hour
...available Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote! Status: Full-... ...Assistance Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust...Remote jobHourly payPermanent employmentFull timeTemporary workLive inCurrently hiringShift work- ...Centene Corp. is hiring a SIU Investigator to conduct fraud, waste, and abuse investigations remotely in Texas. You will review referrals, claims data, medical records, and provider information to identify misconduct and support case resolution. Prepare investigative reports...Remote work
$20 per hour
...in our payment products and stay up to date on latest product fraud trends. Analyze large datasets to identify meaningful signals... ...Accounting). 3+ years of work experience in online fraud investigations, trust and safety, and/or cybersecurity. Experience in...Contract workTemporary workWork experience placementRemote work- Sentara Health Plans is seeking an Associate Fraud and Abuse Investigator / Certified Professional Coder (CPC) for a remote role. The position supports remote work with annual travel to Virginia Beach and requires 40 hours per week as a full-time, permanent role. The role...Remote jobPermanent employmentFull time
- Commercial and personal line insurance carriers rely on EXL as a key business partner through our Castle High Value and EXL Risk Control service offerings. We offer a variety of field inspections and risk control services to support our clients’ underwriting processes....For contractorsWork at officeLocal areaWork from home
- Regions Bank is seeking a Fraud Data and Analytics Analyst to transform data for operational decision making with a focus on fraud threats. You will work with senior analysts and managers to deliver insights that help protect the bank from losses. The role emphasizes data...Remote job
$28 - $38 per hour
...gives people the confidence to reach further. Overview We are currently seeking a Senior Fraud Analyst. The Senior Fraud Analyst will be responsible for identifying, investigating and mitigating potential fraudulent activity involving users of our new online and mobile...- Sedgwick Claims Management Services Ltd is seeking a Senior Adjuster to investigate complex insurance claims, determine coverage, and negotiate settlements. You will interview claimants, inspect property damage, and prepare detailed reports while coordinating with legal...
- Amrize is seeking a Warranty Investigator to protect the company’s Building Envelope interests by managing warranty claims. The role involves receiving, analyzing, and determining claims based on data from all available resources and negotiating resolutions with contractors...Remote jobFor contractors
- ...support. Responsibilities include analyzing financial information, assisting with litigation discovery, and playing a key role in fraud investigations. Candidates should possess a Bachelor's degree in Finance or Accounting, along with a minimum of 3 years of relevant...Flexible hours
$59.47k
...modify, or update your information by visiting and logging into the careers section of the system. Job Description: At Regions, the Fraud Data and Analytics Analyst transforms data into a meaningful format for operational and/or decision-making purposes, with a specialization...Full timeWork at officeRemote workWork from homeVisa sponsorshipWork visaFlexible hours3 days per week- TEKsystems is seeking a Contract Fraud Analyst in Austin, TX to master our adversarial payments ecosystem and stay ahead of fraud trends. You will analyze large datasets to uncover meaningful signals and use in-house tools to label signals, images, and payments according...Remote jobContract work
- East West Bank is seeking a Senior Fraud Analyst to identify, investigate, and mitigate fraudulent activity across online and mobile banking and related services. The role focuses on detection, case management, and policy enhancement to protect customers and the institution...
- TEKsystems is seeking a remote fraud analyst to join an operations team focused on payments fraud, protecting Meta users and partners... ...tickets while applying a diverse toolkit of data analysis and investigative work. The role requires 3+ years in fraud investigations or...Remote job
- Integra FEC is seeking a research analyst to partner with quantitative analysts to develop and enhance fraud-investigation methods. The role focuses on researching fraud across financial, securities, cryptocurrency, and health care domains. The analyst will review academic...Internship
- ...Evaluates and makes recommendations concerning departmental productivity and accomplishments of department's goals and objectives.Investigates circumstances surrounding violations of law and University regulations or policies.May be required to perform direct law...
- Progressive Insurance is seeking a senior claims specialist to investigate complex and high-risk injury claims, coordinating with police, medical professionals, claimants and attorneys as needed. This role supports determining coverage, liability and the total value of...Full timeWork at officeDay shiftAfternoon shift
- ...Investigates property crimes.Investigates crimes against persons.Collect, preserve, and analyze evidence.Prepare detailed reports and maintain accurate and complete case files.Interview suspects and witnesses.Collaborate with outside agencies.Testify in court proceedings...
$25 per hour
Vikki Goodwin for Lieutenant Governor: Communications Fellow LOCATION TX SALARY $25 - $25 (Hourly) ARENA-TRAINED STAFF This role was posted by Arena-Trained employer. SECOND LANGUAGE Spanish — Second Language Preferred COMPANY Vikki Goodwin for Lieutenant Governor ...Hourly payAfternoon shift- ...by conducting advanced forensic examinations, eDiscovery, and investigative analysis across a wide range of digital platforms. This position... .... Conduct HR-related investigations, eDiscovery for lawsuits, fraud, misuse/abuse investigations, and internal police or city...Work at officeLocal area
- ...Comply and promote LodgeWorks standards and regulations to encourage safe and efficient hotel operations. Initiate preliminary investigations into incidents. Documents and reports to supervisor. Maintain regular attendance in compliance with LodgeWorks standards as...Full timeTemporary workLocal areaHome officeFlexible hoursShift work
$4,250 - $4,800 per month
Vikki Goodwin for Lieutenant Governor: Finance Assistant LOCATION Austin, TX SALARY $4250 - $4800 (Monthly) ARENA-TRAINED STAFF This role was posted by Arena-Trained employer. DESIRED SKILLS Managed financial call time COMPANY Vikki Goodwin for Lieutenant Governor ...Weekend workAfternoon shift- Risk & Regulatory Consulting, LLC (RRC) seeks a seasoned Financial Examiner, EIC to lead risk-focused financial examinations for state insurance departments. The role involves supervising examination teams, evaluating solvency, and ensuring regulatory compliance across ...Remote job
- Mayer Consulting specializes in criminal defense investigation, mitigation, and voir dire support Focused on delivering high-quality services, Mayer Consulting works closely with attorneys and their clients to ensure thorough and accurate investigations. We are dedicated...Part time
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