Program Integrity Investigator-162010,162126
Adams County, Westminster, CO, United States
This position is designed for an experienced Community Support Case Manager who is highly skilled in the accurate and timely issuance of all programmatic benefits. Investigators work in both an independent and team-oriented atmosphere while utilizing strong behavioral, analytical, communication and customer service skills to investigate allegations of possible program eligibility abuse and fraud, apply findings to public assistance cases and determine intentional program violations. They will provide clear and concise reports documenting findings together with the communication skills necessary to testify in Adams County Administrative Hearings and Civil Court. Investigators are expected to remain highly proficient with all current and future program policy requirements, and in the use of analysis tools, including Microsoft Excel, Access and other databases and computer systems.
Responsibilities
Conduct thorough and professional investigations into concerns about program violations and fraud, including extensive research in multiple databases, client interviews, phone calls and home visits to obtain needed verification and evidence.
Communicate with various entities and individuals such as customers, landlords, employers, lawyers, human service workers and schools to obtain sufficient and accurate evidence and verification.
Write clear and concise reports of investigations completed.
Clearly communicate relevant program rules to households in verbal and written form.
Keep organized digital files of reports, findings and evidence.
Apply program rules to the information discovered to determine if and when the information should have been known to the County and should have affected the household’s benefits.
Utilize information gleaned from investigations to complete a thorough review of the household’s eligibility status, decide if a household received benefits it was not eligible for, determine if an intentional program violation (IPV) is warranted and decide if civil action is appropriate.
Complete data entry in the Colorado Benefits Management System to apply investigative findings to each case and ensure correct, effective timeframes and outcomes, including any resulting overpayments, and establish claims in accordance with program rules and guidelines.
Ensure all actions taken are properly documented in the Colorado Benefits Management System.
Prepare evidence, attend and testify in state level hearings on applicant/participant appeals and county conferences.
Complete and send required documentation to communicate claim information to liable individuals timely in accordance with program regulations.
Provide coverage for other functions of the Program Integrity unit as needed, including work assigned to the recovery specialists and administrative assistant.
Knowledge Of:
Eligibility rules and regulations for all assistance programs, including:
Adult Financial
Colorado Works
Food Assistance
Medical Assistance
Case processing policies and procedures.
Office and internal policies and procedures.
Basic methods utilized in investigations.
Techniques used to obtain pertinent information during an interview.
Strong knowledge of computers with the ability to learn and utilize a variety of new programs to gather information.
Ability to:
Conduct thorough and professional interviews through a customer service lens.
Research past client history and current program eligibility to determine if a violation is present; and if the information gathered points toward a violation, provide all documentation to support the case for use in an Administrative Hearing and/or Civil court.
Research and interpret rules to apply to a variety of complex situations and timeframes.
Apply basic math and read, interpret, and apply manual regulations.
Communicate clearly and concisely, both verbally and in writing.
Write complete, clear, detailed and concise reports.
Work quickly and accurately with minimal supervision to complete time‑sensitive tasks.
Develop and maintain positive working relationships with those contacted during work.
Differentiate between relevant and non‑relevant information when making eligibility decisions, creating claims and determining intentional program violations.
Input data accurately and detect errors/make corrections.
Maintain objectivity and confidentiality.
Work effectively and positively with individuals of diverse cultural and socioeconomic backgrounds and educationally diverse populations.
Personally commit to champion the County’s norms and values as an individual and professional commitment to design facilitation for others that reinforce the County’s cultural expectations.
Experience
At least two (2) years of experience determining eligibility for multiple programs is required.
Experience as a Community Support Case Manager II/III with consistently high case productivity and accuracy rates is preferred.
Working experience and knowledge of all programs—Adult Financial, Colorado Works, Food Assistance, Medical Assistance, LTC—is preferred but not required, with an expectation to learn all programs once hired.
Education and Training
High school diploma or GED equivalent required.
Additional analytical, statistical or other related higher education is preferred.
Bilingual in English/Spanish is preferred.
License or Certificate
None.
Background Check
Must pass a criminal background check.
Other
Ability to work in a standard office environment.
Ability to utilize personal vehicle or other mode of transportation to conduct field investigations as needed.
Ability to obtain, maintain, and ensure continued access to State and County systems in strict compliance with all applicable county and state regulations, policies, and user agreements.
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Responsibilities
Conduct thorough and professional investigations into concerns about program violations and fraud, including extensive research in multiple databases, client interviews, phone calls and home visits to obtain needed verification and evidence.
Communicate with various entities and individuals such as customers, landlords, employers, lawyers, human service workers and schools to obtain sufficient and accurate evidence and verification.
Write clear and concise reports of investigations completed.
Clearly communicate relevant program rules to households in verbal and written form.
Keep organized digital files of reports, findings and evidence.
Apply program rules to the information discovered to determine if and when the information should have been known to the County and should have affected the household’s benefits.
Utilize information gleaned from investigations to complete a thorough review of the household’s eligibility status, decide if a household received benefits it was not eligible for, determine if an intentional program violation (IPV) is warranted and decide if civil action is appropriate.
Complete data entry in the Colorado Benefits Management System to apply investigative findings to each case and ensure correct, effective timeframes and outcomes, including any resulting overpayments, and establish claims in accordance with program rules and guidelines.
Ensure all actions taken are properly documented in the Colorado Benefits Management System.
Prepare evidence, attend and testify in state level hearings on applicant/participant appeals and county conferences.
Complete and send required documentation to communicate claim information to liable individuals timely in accordance with program regulations.
Provide coverage for other functions of the Program Integrity unit as needed, including work assigned to the recovery specialists and administrative assistant.
Knowledge Of:
Eligibility rules and regulations for all assistance programs, including:
Adult Financial
Colorado Works
Food Assistance
Medical Assistance
Case processing policies and procedures.
Office and internal policies and procedures.
Basic methods utilized in investigations.
Techniques used to obtain pertinent information during an interview.
Strong knowledge of computers with the ability to learn and utilize a variety of new programs to gather information.
Ability to:
Conduct thorough and professional interviews through a customer service lens.
Research past client history and current program eligibility to determine if a violation is present; and if the information gathered points toward a violation, provide all documentation to support the case for use in an Administrative Hearing and/or Civil court.
Research and interpret rules to apply to a variety of complex situations and timeframes.
Apply basic math and read, interpret, and apply manual regulations.
Communicate clearly and concisely, both verbally and in writing.
Write complete, clear, detailed and concise reports.
Work quickly and accurately with minimal supervision to complete time‑sensitive tasks.
Develop and maintain positive working relationships with those contacted during work.
Differentiate between relevant and non‑relevant information when making eligibility decisions, creating claims and determining intentional program violations.
Input data accurately and detect errors/make corrections.
Maintain objectivity and confidentiality.
Work effectively and positively with individuals of diverse cultural and socioeconomic backgrounds and educationally diverse populations.
Personally commit to champion the County’s norms and values as an individual and professional commitment to design facilitation for others that reinforce the County’s cultural expectations.
Experience
At least two (2) years of experience determining eligibility for multiple programs is required.
Experience as a Community Support Case Manager II/III with consistently high case productivity and accuracy rates is preferred.
Working experience and knowledge of all programs—Adult Financial, Colorado Works, Food Assistance, Medical Assistance, LTC—is preferred but not required, with an expectation to learn all programs once hired.
Education and Training
High school diploma or GED equivalent required.
Additional analytical, statistical or other related higher education is preferred.
Bilingual in English/Spanish is preferred.
License or Certificate
None.
Background Check
Must pass a criminal background check.
Other
Ability to work in a standard office environment.
Ability to utilize personal vehicle or other mode of transportation to conduct field investigations as needed.
Ability to obtain, maintain, and ensure continued access to State and County systems in strict compliance with all applicable county and state regulations, policies, and user agreements.
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