Medicaid Fraud Investigator (8 positions)

$54,197 - $74,000/Yr

North Carolina Dept of Justice - Wake Forest, NC

Full-time - Entry Level

Wake Forest, NC

1,001-5,000 employees

About the position

The Medicaid Fraud Investigator position at the North Carolina Department of Justice focuses on investigating criminal and civil Medicaid fraud schemes, patient abuse, and misappropriation of recipient funds. The role involves conducting detailed financial analyses, preparing investigation reports, and collaborating with various law enforcement and judicial personnel. This position is part of a newly expanded team aimed at enhancing the state's efforts to combat Medicaid fraud, ensuring the protection of taxpayer funds and access to healthcare services for vulnerable populations.

Responsibilities

• Conduct investigations into criminal and civil Medicaid fraud schemes, patient abuse, and misappropriation of recipient funds.
• Perform detailed analysis of Medicaid and Medicare claims and reimbursement data.
• Prepare detailed spreadsheets and charts to analyze the flow of payments.
• Review and analyze complex medical and billing data as well as medical records.
• Prepare written investigation reports and serve subpoenas.
• Conduct surveillance and execute search warrants.
• Research public records and analyze complex documents.
• Interview and coordinate with witnesses, preparing statements and affidavits.
• Communicate and consult with subjects, law enforcement, and judicial personnel.
• Testify in judicial proceedings and maintain confidentiality during investigations.
• Participate in the collection and storage of evidence, including electronic data.
• Assist with undercover investigations and other law enforcement operations.

Requirements

• Bachelor's degree in accounting, finance, business administration, or criminal justice with eighteen credit hours of accounting coursework and two years of experience in auditing and/or investigating tax, financial, or securities crimes.
• Intermediate knowledge of state and federal tax, financial, and/or securities laws and regulations.
• Intermediate knowledge of audit methodologies and/or forensic accounting methods.
• Intermediate knowledge of investigative examination processes and procedures.
• Ability to work independently and as part of a team, maintaining confidentiality and discretion.

Nice-to-haves

• Experience in forensic accounting or financial investigations.
• Knowledge of Medicaid and Medicare regulations.
• Familiarity with judicial procedures and law enforcement operations.

Benefits

• Employer paid health insurance
• Twelve paid holidays
• Generous vacation and sick leave accrual
• Dental and vision insurance options
• Retirement benefits