Compliance Investigator - Consumer Protection (Medicaid Fraud Control Unit)

The Consumer Protection Section is seeking an experienced investigator to join the Medicaid Fraud, Abuse, and Neglect Unit (MFANU) and help protect Colorado’s Medicaid program and vulnerable individuals from fraud, abuse, and neglect. This position offers the opportunity to conduct complex civil and criminal investigations, analyze financial, medical, and other investigative evidence, conduct interviews, develop investigative strategies, and work alongside attorneys, special agents, analysts, and law enforcement partners to build cases and support enforcement actions. The ideal candidate is an analytical and resourceful investigator who exercises sound judgment, can independently manage complex investigations, and is skilled at turning large volumes of information into clear, well-supported investigative findings. If you are motivated by challenging investigative work, collaboration, and meaningful public service, we invite you to apply and learn more about this opportunity!
 
WHO WE ARE
 
The 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.
Visit our website to learn more: https://coag.gov/.

ABOUT THE UNIT

The Colorado Medicaid Fraud, Abuse, and Neglect Unit (MFANU) conducts civil and criminal investigations, litigation, and prosecution of fraudulent activity by Medicaid providers (such as hospitals, doctors, pharmacies, nursing homes, etc.) and of patient abuse (such as physical assault, sexual assault, homicide and embezzlement of patient trust funds). 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.

ABOUT THE POSITION

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: 

Investigative/Case Prep

• 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.

Investigative Analysis and Intelligence Development

• Collect, evaluate, analyze, and synthesize complex investigative, financial, medical, and intelligence information from public records, criminal justice databases, Medicaid claims data, law enforcement systems, and other investigative sources.
• Conduct detailed financial and data analysis to identify fraudulent billing patterns, quantify fraud damages, calculate suspect liability, and distinguish between multiple types of fraudulent activity while eliminating duplicate claims and payments.
• Utilize investigative analysis techniques, including charting, timelines, link analysis, telephone toll analysis, search warrant return analysis, and other analytical methods to identify relationships, investigative leads, and patterns of unlawful conduct.
• Conduct interviews, gather investigative information, and collaborate investigative activities with special agents, attorneys, analysts, and external law enforcement agencies to develop investigative findings and determine appropriate civil or criminal enforcement strategies.
• Apply critical thinking, professional judgment, and inductive reasoning to evaluate investigative findings, develop investigative hypotheses, identify evidentiary gaps, and recommend additional investigative actions.
• Prepare comprehensive investigative reports, charts, presentations, and other analytical work products that clearly communicate investigative findings and support prosecutorial decision-making.
• Identify investigative trends, connections, and overlapping evidence across multiple investigations; communicate significant findings to investigative teams; and recommend new investigations when evidence indicates additional fraudulent activity or previously unidentified suspects.

Document Preparation & Report Writing 

• Maintain, organize, and preserve investigative records, evidence, and large volumes of information within investigative case management systems to ensure the integrity, accessibility, and admissibility of records for civil and criminal proceedings. 
• Analyze and synthesize investigative, financial, medical, and documentary evidence obtained from businesses, consumers, suspects, witnesses, employees, former employees, and other sources into clear, concise, and accurate investigative reports, affidavits, charts, presentations, spreadsheets, graphs, and other evidentiary work products. 
• Prepare comprehensive case summaries that accurately document investigative findings, including exculpatory information, investigative methodologies, and supporting evidence for use by attorneys during charging decisions, settlement negotiations, administrative actions, and court proceedings.

Outreach & Education

• Engage in informational meetings and outreach to the public to educate them on the mission of the MFANU.

• Build relationships with other government agencies in Colorado and elsewhere using knowledge of the state’s Medicaid statutes, providing them with assistance, guidance, and training when needed and requested.

Salary note: Although a salary range is listed, salary will be set commensurate with the successful candidate's qualifications and in compliance with the Equal Pay for Equal Work Act.

This recruitment may be used to fill multiple positions in the Department of Law, Consumer Protection Section.WHAT WE ARE LOOKING FOR
 

Class Code & Classification Description:

H6K3XX

Compliance Investigator II

Minimum Qualifications and Substitutions: Please document all relevant experience in detail on your application. Experience will not be inferred or assumed. Any part-time experience listed will be prorated. 

Experience Only:

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

Education and Experience: 

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.

If substituting education for experience, transcripts must be provided at time of application. Candidates possessing a foreign degree must submit a translation (evaluation) of the degree from an accredited institution, such as The National Association of Credential Evaluations Services in order to be given credit for the degree.

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.

HOW TO APPLY
 
Required Application Materials
 

1. 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.
2. Resume 
3. 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.

Veteran’s Preference: In order to be considered for veteran’s preference you must attach a copy of your DD214 forms as well as any documentation required to prove disability or marital status.
 
Your application will be reviewed by a qualified Human Resources Specialist to determine if you meet the minimum qualifications for this position. If your application does not demonstrate that you meet the minimum requirements, you will be notified that you will not proceed in the selection process for this position. If your application is rejected and you have questions, you may contact Mercedes Chansisourath at 720-508-6793 or [email protected].  
 
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. 

It is imperative that the “Work Experience” section of your application is complete and specifically addresses your qualifications, experience, work product, and accomplishments as they relate to the Description of the Job, Minimum Qualifications, and Preferred Qualifications as listed above. Failure to include adequate information or follow instructions by the closing date may result in your application not being accepted and/or may affect your inclusion in the final pool of eligible applicants as the materials may be used to identify a top group for additional assessment or establish an eligible list for referral to the hiring manager for final consideration.
 
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 refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.

WHY WORK FOR US
 
We Embrace Flexibility
We aim to produce outstanding work product for our clients, be efficient with our time, and support each other as team members – which also means we embrace flexible working arrangements when and where possible.
 
We Are Committed to Diversity, Equity and Inclusion
At the DOL, our commitment to DEI is thriving. We know that we are better together when our differences are valued and everyone is inspired and empowered to contribute. As such, we strive to provide a safe environment where individuals feel valued and respected for who they are; demonstrate a behavior and mindset where differences are welcomed, and individuals are treated equally and empowered to do their best work; and promote growth and innovation through a diverse workforce. We empower an active Diversity Equity & Inclusion Impact Team that creates approaches to ensure safe spaces and a culture supportive of people being their authentic selves, hosts events and programs on DEI areas important to our employees, enables development and sustainability of resource groups that give a voice to historically marginalized populations, focuses on retaining our incredible talent, and more!  If your professional goals include promoting growth and innovation with colleagues who recognize that we are better together when our differences are valued and respected, then DOL is your place to be!
 
We Have Strong Core Values
Our core values drive our actions. At the Department of Law, we are: 1) principled, maintaining the highest ethical standards, rigorous legal analysis, and careful evaluation of facts; 2) public servants, who are always ensuring our work is not about us, but instead is about the people of Colorado; 3) innovative, by seeking to identify the best approach, make deliberate decisions, and look to improve; and 4) "better together," by working to support each other and collaborate.
 
We are Committed to Developing our Employees
We are deeply invested in our talent and regularly provide meaningful opportunities for personal and professional growth through training and coaching. Further, our professional development and performance goal setting process is collaborative and ongoing, and aimed at helping our employees grow and succeed.
 
We Offer Excellent Benefits
In addition to the comprehensive State of Colorado benefits package including competitive medical and dental health plans, employer-paid life insurance, paid holidays, retirement plans with Colorado PERA, and vacation and sick leave earned each month, there are many other unique benefits that we offer, including:

• Medical and dental health plans
• Employer-paid life insurance
• Paid vacation and sick leave earned each month
• 11 paid holidays per year
• Public Service Loan Forgiveness – A borrower may qualify for forgiveness by making 120 on-time payments while employed full-time in public service, if they have certain kinds of federal loans in a qualifying repayment plan
• Free access to an on-site fitness center
• Strong, flexible retirement benefits including 401K and 457 plans
• Distinctive career advancement opportunities throughout the State personnel system
• Excellent work-life programs, such as flexible work schedules, professional development opportunities, and an employee discount program

To learn more about our benefits visit: https://www.colorado.gov/dhr/benefits.
 
The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.
 
The Department of Law is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Julie Christopher at [email protected].