Compliance Investigator

Summary

Compliance Investigator IIThe Office of the Attorney General/Department of Law is the "People's Lawyer." The Attorney General, Phil Weiser, was elected by the people of Colorado and is the State's chief lawyer and law enforcement official. Our vision for the Department of Law is: "Together, we serve Colorado and its people, advancing the rule of law, protecting our democracy and promoting justice for all." Our core values and commitment to diversity, equity, and inclusion drive our actions and demonstrate our focus on being principled public servants who are innovative and better together.The Colorado Medicaid Fraud, Abuse, and Neglect Unit (MFANU) conducts civil and criminal investigations, litigation, and prosecution of fraudulent activity by Medicaid providers and of patient abuse. This unit receives multiple referrals and evaluates them to determine if they warrant further investigation and criminal prosecution in state court. Often, the unit acts as the lead investigative agency gathering information from partnering law enforcement and regulatory agencies, not limited to numerous local, state and federal agencies within the State of Colorado. This unit also receives investigations from other law enforcement agencies for subsequent prosecution. This unit provides training and technical assistance to law enforcement agencies within the State of Colorado related to Medicaid Fraud.The compliance investigator II conducts complex civil and criminal healthcare fraud investigations involving alleged violations of state and federal Medicaid laws. Independently evaluates allegations of fraud, abuse, and neglect; develops investigative strategies; analyzes complex financial, medical, and investigative information; and gathers, preserves, and evaluates evidence to support civil or criminal enforcement actions. Provides investigative recommendations to attorneys, special agents, analysts, and law enforcement partners throughout the investigative process, prepares investigative reports and litigation support materials, and may serve as the Medicaid Fraud Control Unit's Property and Evidence Manager by maintaining evidence and ensuring compliance with chain-of-custody requirements.Essential duties include but is not limited to the following:Evaluate and follow up on complaints received through the Department's Medicaid Fraud Reporting Portal and other referral sources to determine investigative merit, jurisdiction, and appropriate investigative action.Conduct and coordinate complex civil and criminal investigations involving alleged violations of the Colorado Medicaid False Claims Act, the federal False Claims Act, and other applicable state and federal laws enforced by the Medicaid Fraud Control Unit. Analyze complex investigative, financial, medical, and operational information to identify potential healthcare fraud, Medicaid fraud, abuse, neglect, and other unlawful conduct; develop investigative strategies; and support civil and criminal enforcement actions.Collaborate with attorneys, special agents, analysts, paralegals, and other law enforcement partners to gather, analyze, and preserve evidence; determine whether conduct supports civil or criminal enforcement; and advance investigations through appropriate investigative and prosecutorial strategies.Conduct interviews of witnesses, victims, suspects, and other involved parties; research and obtain documentary, financial, medical, and electronic evidence; evaluate investigative findings; and prepare comprehensive reports, case summaries, and prosecutorial briefings.Independently assess complex and evolving investigative information, identify investigative leads and evidentiary gaps, make real-time investigative recommendations, and coordinate investigative activities to support successful case resolution.Serve as the Medicaid Fraud Control Unit's Property and Evidence Manager, when assigned, by maintaining evidence in accordance with chain-of-custody requirements, conducting inventories, updating procedures, training staff, and ensuring the secure retention and disposition of evidence.Minimum Qualifications and Substitutions: Requires six (6) 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 six years. This experience must include review of initial complaints, follow up investigation, final recommendation, and further compliance.Required Competencies: Ability to independently conduct complex civil and criminal investigations from complaint/referral through case development, including determining investigative merit, identifying leads and evidentiary gaps, developing investigative strategies, and determining appropriate investigative actions. Strong ability to analyze and synthesize complex financial, medical, billing, claims, electronic, and investigative information; identify patterns, discrepancies, relationships, and potential unlawful conduct; develop investigative hypotheses; and draw well-supported conclusions. Ability to exercise independent professional judgment when evaluating allegations and evidence, determining investigative priorities and methodologies, assessing the reliability and evidentiary value of information, and recommending additional investigative or enforcement action. Ability to analyze complex financial and claims data, identify fraudulent billing patterns or questionable transactions, quantify potential damages or liability, and organize large datasets using spreadsheets, databases, charts, timelines, link analysis, or other investigative analytical methods.Preferred Qualifications: In addition to the minimum qualifications, the preferred applicant will also demonstrate and clearly describe the following skills and experience in their job application: Experience conducting complex investigations, including independently evaluating allegations, developing investigative strategies, identifying investigative leads, and determining appropriate investigative actions. Experience investigating healthcare fraud, Medicaid fraud, financial fraud, white-collar crime, abuse or neglect, or other complex regulatory or criminal matters. Experience analyzing complex financial, medical, billing, claims, or other investigative data to identify patterns, discrepancies, relationships, potential fraudulent activity, or evidentiary gaps. Experience obtaining, reviewing, analyzing, and preserving documentary, financial, medical, electronic, or other investigative evidence. Experience conducting interviews of witnesses, victims, complainants, suspects, subjects, or other involved parties as part of an investigation. Experience preparing comprehensive investigative reports, affidavits, case summaries, analytical reports, charts, spreadsheets, presentations, or other investigative work products. Experience managing multiple complex investigations or a substantial investigative caseload, including prioritizing competing assignments and deadlines. Experience collaborating with attorneys, law enforcement agencies, regulatory agencies, analysts, or other investigative partners in developing or advancing investigations. Knowledge of or experience applying state or federal healthcare, Medicaid, fraud, criminal, regulatory, or evidentiary laws and requirements. Experience maintaining evidence and applying chain-of-custody, evidence preservation, or property/evidence management requirements. Proficiency using spreadsheets, databases, case-management systems, criminal justice databases, public-record resources, or other investigative research and analytical tools. Strong analytical and critical-thinking skills, professional judgment, problem-solving ability, and written and oral communication skills.Conditions of Employment: Applicants must pass a thorough background investigation prior to appointment. 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. Qualified applicants must possess and maintain a valid driver's license. This unit offers flexible work arrangements. New employees are generally expected to work in-office a minimum of three days per week. Additional flexibility will be considered for employees after a successful onboarding and training period. Please note, flexible work arrangements may change at any time based on business needs. Position may need to travel and/or stay overnight (several days or weeks are possible) to accomplish testifying and/or participating in court proceedings in various jurisdictions, conduct investigative follow-up (interviews, gathering evidence, etc.) as well as participating in and/or providing training to others. Position may be required, sometimes on short notice, to work outside of regular business hours, including possible early mornings, evenings, weekend, and overnight assignments as necessary to conduct fast-paced investigations and prepare for trial.Required Application Materials: A completed State of Colorado Application: Applicants are responsible for ensuring that the application provided is fully completed and clearly describes their education, training and experience as it relates to this position. Applications left blank or marked "See Resume" will not be considered. Resume Cover Letter: A detailed cover letter explaining your interest in the position, any information regarding your skills, qualifications, accomplishments, etc. and how you meet the listed preferred qualifications is due at the time of application.Assessment Information: Colorado Revised Statutes require that all state employees be hired and promoted through comparative analysis of merit and fitness. Upon meeting the minimum qualifications, the next phase of the process is typically a structured application/resume review by a panel of subject matter experts against the job duties and/or preferred qualifications in this job announcement to determine technical competence, depth and breadth of experience and potential job fit. Technical Competence – Technical experience as it relates to the duties outlined in this job announcement. Depth and Breadth of Experience – Experience that covers multiple areas outlined in this job announcement and demonstrates the level of responsibility assigned. Job Fit – Experience will be evaluated to determine how well experience aligns with and meets the business needs of this position. Current experience is preferred.Appeal Rights: If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director. An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email, US Mail, faxed or hand delivered within ten (10) calendar days from your receipt of notice or acknowledgement of the department's action. For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board go to spb.colorado.gov or

Job Description

Compliance Investigator IIThe Office of the Attorney General/Department of Law is the "People's Lawyer." The Attorney General, Phil Weiser, was elected by the people of Colorado and is the State's chief lawyer and law enforcement official. Our vision for the Department of Law is: "Together, we serve Colorado and its people, advancing the rule of law, protecting our democracy and promoting justice for all." Our core values and commitment to diversity, equity, and inclusion drive our actions and demonstrate our focus on being principled public servants who are innovative and better together.The Colorado Medicaid Fraud, Abuse, and Neglect Unit (MFANU) conducts civil and criminal investigations, litigation, and prosecution of fraudulent activity by Medicaid providers and of patient abuse. This unit receives multiple referrals and evaluates them to determine if they warrant further investigation and criminal prosecution in state court. Often, the unit acts as the lead investigative agency gathering information from partnering law enforcement and regulatory agencies, not limited to numerous local, state and federal agencies within the State of Colorado. This unit also receives investigations from other law enforcement agencies for subsequent prosecution. This unit provides training and technical assistance to law enforcement agencies within the State of Colorado related to Medicaid Fraud.The compliance investigator II conducts complex civil and criminal healthcare fraud investigations involving alleged violations of state and federal Medicaid laws. Independently evaluates allegations of fraud, abuse, and neglect; develops investigative strategies; analyzes complex financial, medical, and investigative information; and gathers, preserves, and evaluates evidence to support civil or criminal enforcement actions. Provides investigative recommendations to attorneys, special agents, analysts, and law enforcement partners throughout the investigative process, prepares investigative reports and litigation support materials, and may serve as the Medicaid Fraud Control Unit's Property and Evidence Manager by maintaining evidence and ensuring compliance with chain-of-custody requirements.Essential duties include but is not limited to the following:Evaluate and follow up on complaints received through the Department's Medicaid Fraud Reporting Portal and other referral sources to determine investigative merit, jurisdiction, and appropriate investigative action.Conduct and coordinate complex civil and criminal investigations involving alleged violations of the Colorado Medicaid False Claims Act, the federal False Claims Act, and other applicable state and federal laws enforced by the Medicaid Fraud Control Unit. Analyze complex investigative, financial, medical, and operational information to identify potential healthcare fraud, Medicaid fraud, abuse, neglect, and other unlawful conduct; develop investigative strategies; and support civil and criminal enforcement actions.Collaborate with attorneys, special agents, analysts, paralegals, and other law enforcement partners to gather, analyze, and preserve evidence; determine whether conduct supports civil or criminal enforcement; and advance investigations through appropriate investigative and prosecutorial strategies.Conduct interviews of witnesses, victims, suspects, and other involved parties; research and obtain documentary, financial, medical, and electronic evidence; evaluate investigative findings; and prepare comprehensive reports, case summaries, and prosecutorial briefings.Independently assess complex and evolving investigative information, identify investigative leads and evidentiary gaps, make real-time investigative recommendations, and coordinate investigative activities to support successful case resolution.Serve as the Medicaid Fraud Control Unit's Property and Evidence Manager, when assigned, by maintaining evidence in accordance with chain-of-custody requirements, conducting inventories, updating procedures, training staff, and ensuring the secure retention and disposition of evidence.Minimum Qualifications and Substitutions: Requires six (6) 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 six years. This experience must include review of initial complaints, follow up investigation, final recommendation, and further compliance.Required Competencies: Ability to independently conduct complex civil and criminal investigations from complaint/referral through case development, including determining investigative merit, identifying leads and evidentiary gaps, developing investigative strategies, and determining appropriate investigative actions. Strong ability to analyze and synthesize complex financial, medical, billing, claims, electronic, and investigative information; identify patterns, discrepancies, relationships, and potential unlawful conduct; develop investigative hypotheses; and draw well-supported conclusions. Ability to exercise independent professional judgment when evaluating allegations and evidence, determining investigative priorities and methodologies, assessing the reliability and evidentiary value of information, and recommending additional investigative or enforcement action. Ability to analyze complex financial and claims data, identify fraudulent billing patterns or questionable transactions, quantify potential damages or liability, and organize large datasets using spreadsheets, databases, charts, timelines, link analysis, or other investigative analytical methods.Preferred Qualifications: In addition to the minimum qualifications, the preferred applicant will also demonstrate and clearly describe the following skills and experience in their job application: Experience conducting complex investigations, including independently evaluating allegations, developing investigative strategies, identifying investigative leads, and determining appropriate investigative actions. Experience investigating healthcare fraud, Medicaid fraud, financial fraud, white-collar crime, abuse or neglect, or other complex regulatory or criminal matters. Experience analyzing complex financial, medical, billing, claims, or other investigative data to identify patterns, discrepancies, relationships, potential fraudulent activity, or evidentiary gaps. Experience obtaining, reviewing, analyzing, and preserving documentary, financial, medical, electronic, or other investigative evidence. Experience conducting interviews of witnesses, victims, complainants, suspects, subjects, or other involved parties as part of an investigation. Experience preparing comprehensive investigative reports, affidavits, case summaries, analytical reports, charts, spreadsheets, presentations, or other investigative work products. Experience managing multiple complex investigations or a substantial investigative caseload, including prioritizing competing assignments and deadlines. Experience collaborating with attorneys, law enforcement agencies, regulatory agencies, analysts, or other investigative partners in developing or advancing investigations. Knowledge of or experience applying state or federal healthcare, Medicaid, fraud, criminal, regulatory, or evidentiary laws and requirements. Experience maintaining evidence and applying chain-of-custody, evidence preservation, or property/evidence management requirements. Proficiency using spreadsheets, databases, case-management systems, criminal justice databases, public-record resources, or other investigative research and analytical tools. Strong analytical and critical-thinking skills, professional judgment, problem-solving ability, and written and oral communication skills.Conditions of Employment: Applicants must pass a thorough background investigation prior to appointment. 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. Qualified applicants must possess and maintain a valid driver's license. This unit offers flexible work arrangements. New employees are generally expected to work in-office a minimum of three days per week. Additional flexibility will be considered for employees after a successful onboarding and training period. Please note, flexible work arrangements may change at any time based on business needs. Position may need to travel and/or stay overnight (several days or weeks are possible) to accomplish testifying and/or participating in court proceedings in various jurisdictions, conduct investigative follow-up (interviews, gathering evidence, etc.) as well as participating in and/or providing training to others. Position may be required, sometimes on short notice, to work outside of regular business hours, including possible early mornings, evenings, weekend, and overnight assignments as necessary to conduct fast-paced investigations and prepare for trial.Required Application Materials: A completed State of Colorado Application: Applicants are responsible for ensuring that the application provided is fully completed and clearly describes their education, training and experience as it relates to this position. Applications left blank or marked "See Resume" will not be considered. Resume Cover Letter: A detailed cover letter explaining your interest in the position, any information regarding your skills, qualifications, accomplishments, etc. and how you meet the listed preferred qualifications is due at the time of application.Assessment Information: Colorado Revised Statutes require that all state employees be hired and promoted through comparative analysis of merit and fitness. Upon meeting the minimum qualifications, the next phase of the process is typically a structured application/resume review by a panel of subject matter experts against the job duties and/or preferred qualifications in this job announcement to determine technical competence, depth and breadth of experience and potential job fit. Technical Competence – Technical experience as it relates to the duties outlined in this job announcement. Depth and Breadth of Experience – Experience that covers multiple areas outlined in this job announcement and demonstrates the level of responsibility assigned. Job Fit – Experience will be evaluated to determine how well experience aligns with and meets the business needs of this position. Current experience is preferred.Appeal Rights: If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director. An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email, US Mail, faxed or hand delivered within ten (10) calendar days from your receipt of notice or acknowledgement of the department's action. For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board go to spb.colorado.gov or