Income Maintenance Investigator II

Primary Purpose A.
Primary Purpose of Organizational Unit: The Community Resource Unit (CRU) provides a variety of direct and indirect supportive services to individuals and families.
These include but are not limited to arrangement of medical transportation for qualified Medicaid recipients, administration of the Low Energy Assistance Program, which provides heating assistance to qualified applicants, determination of eligibility for Work First Assistance and case maintenance for ongoing Work First cases.
The Agency Program Integrity Investigator is also part of the CRU, providing program integrity for a wide variety of agency assistance service programs.
B.
Primary Purpose of Position: The primary purpose of the Program Integrity/Fraud Investigator is to conduct intensive investigations to discover, prevent and recover overpayments/over issuances in the public assistance programs and to monitor and enforce collections or proven overpayments/over issuances.
In addition, the Program Integrity/Fraud Investigator provides a deterrent to public assistance fraud and maintains program integrity.
This position also provides assistance to other units in the Economic Services Division and is the expert in all of the public assistance and special programs in this division.
The Income Maintenance Investigator II-Program Integrity position is responsible for working with considerable independence in investigating fraud or alleged fraud cases in the Income Maintenance programs such as Food and Nutrition Services, Family System Support Services (WF), Low Income Energy Assistance (LIEAP) as well as Emergency Assistance (EA).
Applying Federal and State assistance program policies applicable to each case at this level requires the review of Income Maintenance case files referred to the IM-Investigator II by IMC"s and Supervisors or where fraud allegations are made by individuals within the community, to determine if errors exist and if so, the cause of those errors.
The IM-Investigator II initially evaluates case referrals to determine if the referral is valid and whether more in-depth review is required.
When the cause of error indicates potential client fraud, the IM-Investigator II is responsible for a thorough investigator of the case and the determination of the appropriate course of action required, in order to, resolve the case.
The IM Investigator II works with clients, individual community members, the Agency Attorney, IMC"s and Supervisors, the state Program Integrity Office, the Magistrate"s Office and the judicial system to complete the work of this position.
C.
Work Schedule: The work schedule for this position consists of a five-day, 40-hour work week.
Usual hours are: Monday-Friday, 8:00 a.
m.
to 5:00 p.
m.
with one hour for lunch.
Description of Responsibilities and Duties A system of case management must be maintained to process all case actions by Federal, State and local regulations and in compliance with court orders.
This position requires that the employee have a thorough knowledge and understanding of rules, policies and procedures in all assistance programs.
NC General Statutes, the Judicial System, agency organizational rules, policies and procedures, the ability to recognize, collect and evaluate evidence to support actions, and be abreast of collateral and community resources such as bank, Social Security, VR, etc.
for verifying documents and making appropriate referrals.
The employee in this position must have the flexibility to incorporate constant changes in Federal and State laws, court orders or administrative procedures, which may affect the scope or dynamics of the job.
This position requires extensive public contact in which the IM Investigator-II must communicate effectively with the public, respond to inquiries and represent the agency in negotiations with Attorney, Prosecutor and other judicial officials.
This position works with persons of all ages who are current or past recipients of program services administered by Haywood County Health and Human Services.
This position maintains a caseload that includes a combination of claims in collections, referrals under investigation, and pending referrals.
Major Duties: The employee in this position requires the ability to use various interviewing techniques and skills to elicit information and to explain complex programs and policies in understandable terms to the client, community members, co-workers and others.
This employee must be able to communicate effectively in the exchange of information with those of varied educational, social and economic backgrounds.
Interviews may be conducted by phone, face to face or by mail for simple overpayments or over issuances.
Interviews may take place at the Investigator"s office or the client"s home or a neutral site depending on the client"s physical or mental condition, transportation needs, etc.
It may be necessary for the IM-Investigator II to visit high crime neighborhoods, extremely rural areas, hospitals, nursing and rest homes, detention facilities, judge"s chambers, attorney offices, the DA"s office, grocery stores or other businesses.
The IM-Investigator II is exposed to dangers in the form of physical and verbal abuse from angry, emotionally distraught clients, possible criminal elements, vicious dogs and other animals, communicable disease and adverse weather conditions.
During the interview process with the client, the IM-Investigator II must attempt to establish rapport and gain the trust of the client to ensure the appropriate exchange of information needed to guarantee client and collateral confidentiality.
The IM-Investigator must be able to direct the flow of conversation in order to gather all needed information related to the investigator.
The IM-Investigator must ask questions that allow him/her to determine the level of understanding the client has of his/her rights and responsibilities and the meaning of fraud.
Using that determination, the IM-Investigator must inform the client in understandable terms the status of case investigator regarding suspected fraud/overpayment/over issuance; allowing the client opportunity to reveal information not previously reported to the agency.
This position is required to communicate to the client any suspicions of misrepresentation and confront the client with evidence if necessary.
The IM-Investigator II informs the client of all available programs; assesses the client"s understanding of policy and offers further clarification if needed.
The position will evaluate the need for non-requested services, such as need for legal counsel and make appropriate referrals as applicable.
This worker will check all available agency records in order to evaluate the most accurate events involved in the case and interview any witnesses who may be able to relate significant information.
This position reviews all forms in client"s case file and completes all appropriate forms that are required.
Verification/Documentation: The IM-Investigator II will correspond with clients, collateral sources and community members by appropriate means and document case activity for case records, appeal hearings, fraud investigation and court action.
Based upon information and leads obtained during the interview, a decision is made as to any additional information or documentation needed in determining eligibility during the suspected over issuance/over payment period.
The IM-Investigator must elicit all verifications needed to establish overpayment/over issuance.
The IM-Investigator II must evaluate the information available for accuracy, consistency and appropriateness.
Any discrepancies in information must be resolved.
The IM-Investigator must consult police records, school records, and complete credit checks through the credit bureau as necessary to locate recipients, obtain evidence, reconstruct events in case files that occurred in previous months/years and analyze against appropriate regulations, being mindful that regulation changes could have occurred.
Consult computer records for wage history, UIB eligibility, Social Security and SSI benefits, Veterans Administration Benefits, DMV for resources, status of case in previous jurisdiction (when received from another county or state.
) Compose and generate written communications to both request and provide information such as life insurance cash values, pre-need contracts, fixed income sources (Social Security, Veterans Administration, pensions, etc.
), property and register of deeds transactions, tax rolls, title for current ownership of their interest, estate proceedings, burial plot ownership, post office verification of address in attempts to locate recipient, delinquent payment notices, etc.
Contact collateral sources by telephone or mail for verifications such as employers for wages, terminated sources of income, household composition, etc.
Determination: Once a determination of overpayment/ over issuance is made, the IM-Investigator II is to establish a repayment collection procedure with the client.
The appropriate agreements must be signed.
The IM-Investigator II is responsible for working with the client in establishing the agreement within program guidelines.
This worker is responsible for pursuing collections on claims, including instigating court action if necessary.
Other responsibilities: This position is to analyze each case investigated and prepare a summary on each as to how overpayment / over issuance could have been prevented.
These summaries will be used for corrective action and training of all caseworkers in order to prevent future errors/fraud.
This worker prepares all FSIS forms for computer.
The IM-Investigator II monitors allotment reductions; check deductions, voluntary repayments and court order repayments.
This worker is to prepare and maintain any reports required on all programs, including 4972 report, quarterly program report, electronic day sheets, etc.
This worker must know how to use the reports from FSIS and Raleigh to confirm case data.
This worker is expected to keep the Income Maintenance Supervisor II, Economic Services Director, and Agency Director informed on a timely basis of all fraudulent activities, including a monthly Program Integrity/Fraud Status report.
This position is to attend Program Integrity/Fraud workshops, training sessions deemed appropriate by Supervisor and/or Director; to maintain program manuals, special investigation handbook and other related materials.
This position works closely with all agency staff regarding fraudulent activities.
This position explains Program Integrity/Fraud program and activities to the community as requested and approved by the Director.
This Income Maintenance Investigator-II will be expected to perform other duties as assigned by the IMS-II, Economic Services Director, and/or the Agency Director.
Qualifications 1.
Required Minimum Training: An Associate Degree in Human Services Technology, Social Services Associate, Paralegal Technology, Criminal Justice, Business Administration, Secretarial Science or closely related curriculum and two years of experience as an Income Maintenance Caseworker or Investigator; OR Graduation from high school and three years of experience as an Income Maintenance Caseworker or Income Maintenance Investigator; OR Graduation from high school and two years of investigative experience in credit, legal or law enforcement work plus eighteen (18) months of experience as an Income Maintenance Caseworker or Income Maintenance Investigator; OR an equivalent combination of training and experience.
2.
Additional Training/Experience: Ongoing training is encouraged.
3.
Equivalent Training and Experience: None.
Knowledge, Skills and Abilities Special Requirements - The IMC Investigator will have thorough knowledge of manuals, rules and procedures used in determining eligibility, thorough knowledge of investigative procedures and techniques, and thorough knowledge of rules, regulations, policies, and procedures of the judicial system.
Good mathematical reasoning and computational skills, considerable knowledge of agency"s organizational rules, policies, and procedures, ability to recognize, collect and evaluate evidence to support actions, the, ability to communicate effectively with applicants, community agencies, law enforcement agencies, and judiciary personnel to obtain or present pertinent data, and to negotiate agreement and/or cooperation, ability to maintain effective working relationships with other employees, the general public and the judicial system, and the ability to present information orally or in written form.
Physical Requirements Position requires mostly sedentary work that will occasionally require walking or standing for brief periods of time.
Requires exerting up to 10 pounds of force on a recurring basis as well as routine keyboard operations.
The job requires normal visual acuity and field of vision, hearing and speaking ability.
The position risks no exposure to environmental hazards.
Physical Effort: Great physical effort is not necessarily a part of the job, but long hours to attend evening meetings or to work on agency related matters may be required.
Occasional travel out of town may also be necessary.
Stamina is required to endure and resolve crisis oriented work situations.
Haywood County is an Equal Opportunity Provider and Employer.
ADA requires the County to provide reasonable accommodations to qualified individuals with disabilities.
Prospective and current employees are invited to discuss accommodations.
Additional Information ADDITIONAL REQUIREMENTS FOR POSITION: Applicants must submit official college transcripts (if applicable).
Applicants must have NC Driver"s License and access to a vehicle.
The applicant must have a clean driving record with no more than three (3) points showing on current DMV record.
COMPLETION OF APPLICATION: Applicants will be given credit only for information provided in response to the announcement and included on the completed application.
Applications should include at least ten (10) years of work experience on the application (if applicable).
No additional information will be solicited or considered by this office; therefore individuals who submit incomplete applications may not receive full credit for their education, training and experience.
Applicants will not automatically be given credit based on their position or title.
Applicants must be 21 years of age Job Advertisement Employer paid Health & Dental Coverage Participation in the NC Retirement System 401(k) and 457(b) plans available Employer paid Life Insurance Competitive Vision Insurance Annual Performance Pay Increases Vacation, Personal, and Sick Leave Free Employee Assistance Network Free Employee Wellness Clinic Discounted Gym Membership Paid Holidays Longevity Pay Disclaimer The successful candidate will be subject to a criminal background check.
This institution is an equal opportunity provider and employer.