Full-time Remote 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. 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. Business and Financial Operations
Shift: Day
Additional Shift:
Telework: Eligible for Telework
Travel: Up to 25%
Regular/Temporary: Full Time/Part Time: Full time
Facility Location:
This Investigator VI is selected and managed by the Major Case Unit (MCU) manager within the Investigations & Utilization Reviews (I&UR) division of the Office of Inspector General (OIG). Performs highly advanced (senior level) investigative work involving allegations of fraud, waste, and/or abuse in the provision and delivery of all health and human services in the state. This role requires interviewing skills, extensive research & data analysis, advanced investigative skills, and the development of complex investigative reports. Work involves up to 25% statewide travel, which may include some overnight travel. The investigator works minimal supervision with extensive latitude for the use of initiative and independent judgment.
Research, review, and objectively investigate complex cases alleging fraud, waste, and/or abuse in the provision and delivery of all health and human services in the state. Interprets and applies applicable agency, state and federal policies, procedures, rules, and regulations. Performs timely investigative analysis in conformity with applicable policies and procedures. (Develop comprehensive fact-based exhibits to ensure effective case presentations in administrative hearings and court cases, when required. Testifies and presents evidence in informal reviews and judicial proceedings (before administrative, civil, and criminal courts) as needed. (Research potential interviewees related to the investigation. Provides law enforcement assistance in criminal fraud cases to criminal investigators and prosecutors when necessary. Establishes liaisons with the Office of Attorney General’s Medicaid Fraud Control Unit, the Healthcare Program Enforcement Division, Managed Care Organizations (MCOs) other state and federal agencies, licensure boards, and other external entities to discuss and/or coordinate complex cases alleging fraud, waste, and/or abuse in the provision and delivery of all health and human services in the state. (Reviews, develops, and recommends guidelines, procedures, policies, rules, and regulations to detect and prevent fraud, waste, and program abuse in the provision and delivery of all health and human services in the state. Self-initiates cases or projects designed to generate cases to prevent, detect and investigate fraud, waste and abuse not reported through the OIG referral process. (Performs other duties as assigned or required to maintain division operation. Knowledge of the laws governing the activities regulated by the agency, court procedures, rules of evidence, criminal prosecutions, civil actions, and contract law.
Knowledge of Medicaid program policies and procedures.
Knowledge of fraud and abuse rules and regulations.
Knowledge of business structures (corporate, partnership, LLC)
Ability to understand, interpret, and appropriately apply policies, procedures, rules, and regulations.
use data analytics to analyze investigative date, use AI for complex searches, conduct interviews and gather facts; Ability to communicate effectively both orally and in writing.
Ability to use personal computers and related software to analyze complex queries using advanced functions and formulas in Microsoft Excel, Power BI, and other applications as required.
work under time constraints and under minimal supervision.
Ability to travel up to 25% of the time, to include statewide and/or overnight travel.
Ability to integrate complex regulatory concepts, procedures, and processes.
Skilled in creating comprehensive reports, analyzing data insights, and developing clear, impactful visualizations and preparing correspondence using Microsoft Word to respond to requests and document investigative findings.
Certified Fraud Examiner (CFE) certification preferred.
Graduation from an accredited four-year college or university.
Experience in writing detailed reports.
Experience operating personal computers and software.
Experience in investigative research and analysis
Interviewing and report writing skills
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.

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 HHS Employee Service Center at View phone number on aiapply.co. 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.
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 View phone number on aiapply.co. 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.