Program Integrity Investigator-162010,162126

What Success Looks Like In This Job

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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 coupled 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, as well as in the use of analysis tools, including Microsoft Excel, Access, and other databases, and computer systems.

Examples of Duties for Success

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• Conduct thorough and professional investigations into concerns of 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/when the information should have been made 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 to receive, 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.

Qualifications for Success

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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 investigating.
• Techniques used to obtain pertinent information during an interview.
• Strong knowledge of computers coupled 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. If the information gathered points toward a violation; provide all documentation to support your case so that it may be used in an Administrative Hearing and/or Civil court.
• Research and interpret rule 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 violation.
• 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 facilitations for others that reinforce the County's cultural expectations.

More Qualifications for Success

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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.

+ There is 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.

Adams County and the 17th Judicial District Attorney's Office complies with Colorado’s Job Application Fairness Act (“JAFA”). JAFA prohibits employers from asking individuals to disclose their age, date of birth, or dates of school attendance or graduation on an initial employment application. However, additional application materials such as certifications and transcripts containing this information may be required for certain positions; if such additional materials are requested, applicants may redact information that identifies the applicant’s age, date of birth, or dates or attendance or graduation.