L&I Medical Provider Fraud Investigator
State of Washington - Tumwater, WA

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As the Medical Provider Fraud Investigator, you’ll conduct investigations of alleged provider fraud and abuse. Investigations can include provider billing practices, misconduct and false reporting practices.
You’ll protect the Industrial Insurance Fund against fraud by medical providers by aggressively investigating allegations of inappropriate activity, theft and deception against the Department of Labor & Industries.

Some of what you’ll do
  • Use your people skills to conduct interviews of alleged medical provider fraud.
  • Conduct research to investigate allegations through reviewing documents and other evidence for case development.
  • Compile evidence, facts and findings in a clear and concise manner, addressing allegations and supporting information when making a final recommendation.
  • Prepare and submit detailed and well-written investigation reports.
  • Manage the high stress dynamics of this unique opportunity.
  • Maintain open dialogue with your Supervisor regarding status update of your investigations caseload.
  • Investigate civil and criminal allegations of provider fraud
  • Presents case files to prosecutor for adjudication
  • Advise agency regarding alleged violations of statutes and policies’, provide documentary evidence and present case files
  • Testify at trials or hearings.

Who should apply
Medical Program Specialists and Investigators with 2 years experience investigating insurance casualty claims, billings, medical providers, personal backgrounds, unfair and deceptive business practices or other medically related fields.
2 years of directly related college course work could substitute for one year of the investigative experience.
Ability to travel throughout the state to conduct interviews and investigations is required for this position and incumbent may need to provide their own transportation, if Motor Pool vehicles are unavailable.

What we’re looking for
  • Experience writing technically complex and concise investigative reports, and business correspondence.
  • Effective verbal communication skills and deal with various situations where such skills are essential.
  • Chain of custody-knowledge of the rules of evidence.
  • Experience investigating medical claims or allegations of fraud by medical providers.
  • Proven research and analytical skills; ability to evaluate and draw conclusions from data, support recommendations with fact and analysis, and interpret and apply rules, laws, policies, and procedures
  • Impeccable work ethic, dependable and proactive.
  • Professional represents L&I, illustrate integrity, trust and professionalism.
  • Demonstrated organizational skills and able to manage multiple priorities effectively.
  • Coursework or training in interviewing and interrogation, report writing, rules of evidence, with emphasis in police science or law.
  • Skilled using computers with an emphasis on Microsoft Word, Excel and Outlook.
Supplemental Information:

This job announcement may be used to fill multiple vacancies

Employees driving on state business must have a valid driver’s license. Employees driving a privately owned vehicle on state business must have liability insurance on the privately owned vehicle.

Prior to any new appointment into L&I a background check, including criminal record history, will be conducted.

To apply, follow the "Apply" link above
Jobs advertised as Open Continuous will be closed without notice. It is to your advantage to apply quickly.
Only complete applications will be considered. Be sure to answer all supplemental questions.

We’re looking for evidence that you have the skills, experience, and abilities indicated in this announcement. Information you provide will be used for deciding who'll be selected for the next step in our process.

For more information about the Department of Labor & Industries visit: http://www.lni.wa.gov/
OR
Contact us at: Jobs@LNI.wa.gov

Persons with a disability, who need assistance in the application process, or those needing this announcement in an alternative format, may call (360) 902-9152. Applicants that are deaf or hard of hearing may call through the Washington Relay Service at 7-1-1.
The State of Washington is an Equal Opportunity Employer

State of Washington - 14 months ago - save job - block
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