Compliance Investigator I (Medicaid Fraud) Job Details The Colorado Medicaid Fraud, Abuse & Neglect Unit (MFANU) in the Consumer Protection Section has an opportunity for a Compliance Investigator to partner with the Unit’s criminal investigators and attorneys on criminal and civil investigations. This successful candidate will work on a wide variety of investigations focusing on economic crimes as well as abuse and neglect, playing an important role in building on case strategies. For this role, we’re looking for someone with strong analytical ability and criminal justice background. Job Responsibilities The Compliance Investigator will evaluate and follow-up on complaints that come to the DOL through various channels but primarily though the online Medicaid complaint portal. The position conducts investigations of Medicaid Fraud, Abuse, and Neglect complaints, analyzes intake and referral information to determine the existence of violations, scope and pattern of unlawful activity, and direction of the investigation before making recommendations about next steps in criminal investigators. Identifies and investigates violations of Medicaid fraud and other criminal statutes relating to standards of care for vulnerable populations; Meets with and interviews complainants, witnesses, proprietors, and others to obtain information relating to the investigation for enforcement and compliance; Conducts background investigations of suspects and suspect businesses, research and collect public and non-public records, collect financial records, and conduct complex financial analysis; Reviews and analyze financial, business, and other evidence records; and Documents work and tracks patterns/trends in complaints. Minimum Qualifications Requires five (5) years of professional experience in investigation either as an investigator, investigative journalist, auditor or fraud specialist, or other field where you were responsible for conducting investigations. This experience must include review of initial complaints, follow up investigation, final recommendation, and further compliance. OR Requires a combination of full-time college course work from an accredited institute in criminal justice, public administration, or other closely related college course work AND/OR professional experience in investigation either as an investigator, investigative journalist, auditor or fraud specialist, or other field where you were responsible for conducting investigations totaling five years. Preferred Qualifications Experience with Sales Force or similar data management systems Experience with health care compliance and/or auditing medical billing and coding Experience in criminal justice settings Ability to compile and evaluate complex sets of data using spreadsheets, databases or other tools Excellent analytical skills Excellent judgment and decision making Strong problem-solving skills Ability to work with a wide variety of stakeholders Strong written and oral communication skills This position is subject to a background investigation and requires a valid driver’s license. The Colorado Department of Law participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. The Colorado Department of Law is an equal opportunity employer and welcomes applications from diverse candidates. #J-18808-Ljbffr The Colorado Attorney General's Office
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