Fraud Investigator

Under limited supervision, this position performs technical duties in investigating referred cases of suspected fraud or abuse. Reports to the Senior Eligibility Supervisor.

ESSENTIAL JOB FUNCTIONS

Investigates referrals to determine withheld, altered or misrepresented information; receives and logs referrals from multiple sources; contacts employers, schools and other sources; interviews clients; prepares and forwards findings affecting ongoing and pending eligibility to prevent incorrect program payments; calculates incorrect program payments and obtains repayment agreements; and prepares and forwards findings on non-IPV's to worker's supervisor.

Represents agency in court for all fraud cases; determines suitability of case for Administrative Disqualification Hearing; confers with City's Attorney with pending court cases; testifies before Grand Jury and at trial, as necessary.

Initiates voluntary or mandatory collection activities to recover funds from overpayment; pursues voluntary repayment of overpayments when fraud prosecution is not indicated; performs extensive calculations for the amount of overpayment by program category; enters data into state and local computer system and performs necessary inquires, system searches and updates to coordinate related information; prepares reports on fraud and non-fraud activities; and prepares subpoenas for Director's signature.

Notifies staff when disqualifications from benefit program are necessary; sends Food Stamp letter upon receipt of complaint of improper usage; and relays Food Stamp trafficking information to USDA-FNS.

Performs other related work as required. Individual assignments will be determined by supervisor based on current workload and department needs.

Knowledge of Job: Has considerable knowledge of local, state and federal laws, ordinances, rules and regulations governing Social Services programs, as applicable. Has considerable knowledge of the policies, procedures, rules and regulations of programs as administered through Social Services programs. Has considerable knowledge of the forms, documents and manuals associated with multiple benefit programs. Has general knowledge of other programs administered through Social Services and through community human services agencies or volunteer groups. Has general knowledge of the social and economic factors in the community. Has some knowledge of the principles, methods, and techniques of public administration. Is able to use common office machines, including file maintenance programs. Is able to compile technical information from a variety of sources and prepare clear and concise reports. Is able to exercise considerable initiative and independent judgment in analyzing and applying standards to a variety of situations. Is able to communicate effectively in oral and written form. Is able to explain rules, regulations and policies of programs in terms understood by applicants and the general public. Is able to exercise considerable tact, courtesy and discretion in contact with program applicants and clients, and the general public. Is able to exercise considerable discretion in handling confidential files. Is able to establish and maintain effective working relationships as necessitated by work assignments.

Quality of Work: Maintains high standards of accuracy in exercising duties and responsibilities. Exercises immediate remedial action to correct any quality deficiencies that occur in areas of responsibility. Maintains high quality communication and interacts with all city departments and divisions, co- workers and the general public.

Quantity of Work: Maintains effective and efficient output of all duties and responsibilities as described under “Essential Job Functions.”

Dependability: Assumes responsibility for doing assigned work and meeting deadlines. Completes assigned work on or before deadlines in accordance with directives, city policy, standards and prescribed procedures. Accepts accountability for meeting assigned responsibilities in the technical, human and conceptual areas.

Attendance: Attends work regularly and adheres to city policies and procedures regarding absences and tardiness. Provides adequate notice to higher management with respect to vacation time and time- off requests. 

Initiative and Enthusiasm: Maintains an enthusiastic, self-reliant and self-starting approach to meet job responsibilities and accountabilities. Strives to anticipate work to be done and initiates proper and acceptable direction for completion of work with a minimum of supervision and instruction.

Judgment: Exercises analytical judgment in areas of responsibility. Identifies problems or situations as they occur and specifies decision objectives. Identifies or assists in identifying alternative solutions to problems or situations. Implements decisions in accordance with prescribed and effective policies and procedures and with a minimum of errors. Researches problems, situations and alternatives before exercising judgment. Seeks expert or experienced advice when necessary.

Relationships with Others: Shares knowledge with supervisors and staff for mutual and departmental benefit. Contributes to maintaining high morale among all department employees. Develops and maintains cooperative and courteous relationships with department employees, staffers and managers in other departments, representatives from organizations, and the public to maintain good will toward the department and project a good departmental image. Tactfully and effectively handles requests, suggestions and complaints from other departments and persons to maintain good will within the city. Interacts effectively with fellow employees and the public.

Coordination of Work: Plans and organizes daily work routine. Establishes priorities for the completion of work in accordance with sound time-management methodology. Avoids duplication of effort. Estimates expected time of completion of elements of work and establish a personal schedule accordingly. Attends meetings, planning sessions and discussions of time. Implements work activity in accordance with priorities and estimated schedules. Maintains a calendar for meetings and deadlines.

Safety and Housekeeping: Adheres to all safety and housekeeping standards established by the city and various regulatory agencies. Sees that the standards are not violated. Maintains a clean and orderly work place.

Associate's degree in social services administration and 3-5 years of experience in eligibility or conducting investigations; or any equivalent combination of education and experience.

SPECIAL REQUIREMENTS

An acceptable general background check to include a local, state, and federal criminal history check and sex offender registry check. Individuals in this position cannot be listed as having a founded child abuse or neglect complaint. 

In the event of a declared emergency in the city of Portsmouth, individuals in this position are required to work shelter duty and may be called on to perform duties as required to provide for the safety and care of the citizens of the community.

Motor Coordination- Requires the ability to coordinate hands and eyes rapidly and accurately in using a variety of office equipment.

Manual Dexterity- Requires the ability to handle a variety of items, such as office equipment. Must have minimal levels of eye/hand/foot coordination.

Color Discrimination- Requires the ability to differentiate between colors and shades of color.