"Alerted.org

Working Title: Senior Investigator

Job Class: Human Services Program Representative 2

Agency: Human Services Dept

+ **Job ID** : 89660

+ **Location** : St. Paul

+ **Telework Eligible** : Yes

+ **Full/Part Time** : Full-Time

+ **Regular/Temporary** : Unlimited

+ **Who May Apply** : Open to all qualified job seekers

+ **Date Posted** : 10/16/2025

+ **Closing Date** : 11/05/2025

+ **Hiring Agency/Seniority Unit** : Human Services Dept / MAPE DHS Central Office

+ **Division/Unit** : Department of Human Services (DHS) / Office of Inspector General (OIG)-PIO MPAI Investigators 3

+ **Work Shift/Work Hours** : Day Shift / 8:00 a.m. - 4:30 p.m.

+ **Days of Work** : Monday - Friday

+ **Travel Required** : Yes

+ **Salary Range:** $32.40 - $47.76 / hourly; $67,651 - $99,722 / annually

+ **Classified Status** : Classified

+ **Bargaining Unit/Union** : 214 - MN Assoc of Professional Empl/MAPE

+ **FLSA Status** : Nonexempt

+ Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : Yes

The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.

The work you'll do is more than just a job.

At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.

_This position is eligible for_** telework (https://mn.gov/mmb-stat/policies/1422-telework.pdf) **_for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework._

_Approximately, 10% travel._

_This posting is used to fill multiple vacancies._

This position exists to utilize healthcare, accounting, law enforcement, medical coding and/or criminal justice system experience to combat waste, mismanagement, misuse, and fraud in the Minnesota Medical Assistance program. The employee will function independently and as a member of an investigation team in developing and implementing strategies toward fraud detection, comprehensive investigations, and the development of cases that may involve civil, monetary, or criminal case actions. In addition, the employee will plan, develop, and implement strategies that are designed to minimize the opportunities for program abuse.

The position requires the employee independently investigate and assist other investigative staff to initiate, develop, and resolve cases which lead to administrative actions, sanctions, referrals for criminal action, and/or monetary recoveries of county, state and federal funds erroneously or fraudulently received by providers for services to covered in the Minnesota Health Care Programs.

Minimum Qualifications

_**To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.**_

Three (3) years of experience using investigative techniques to detect fraud, abuse, over-utilization, and error in health care claims.

AND

Experience must demonstrate the following:

+ Develop criteria and parameters used to identify provider activity and potential cases for investigation.

+ Analyze fiscal and/or statistical and healthcare claims data to identify discrepancies.

+ Creation of investigative reports, referrals, and other materials for legal review and consideration in civil or criminal cases.

+ Conduct on-site visits for the purpose of obtaining additional information and documentation relating to cases under investigation in order to determine if billed services were actually provided as claimed and appropriately billed in accordance with applicable program provisions.

Preferred Qualifications

+ Global understanding of regulations, law and policy relating to health care services and work in-depth with provisions that directly relate to each given case.

+ Apply a broad-based, comprehensive understanding of federal and state health care policy, rules, laws and requirements that allow for submission and reimbursement of claims adjudicated the Medicaid claims processing system.

+ Resolve any problems relating to provider refusal to allow access to needed records.

+ Auditing and accounting experience

+ Working knowledge of MN 245A and 245G Licensed providers

+ An understanding of claims processing operations, edits, and CPT coding practices sufficient to understand the procedures followed and decisions made by claims processing staff

+ Skilled in writing legal and technical documents, i.e., Notices of Agency Action, correspondence, policies, procedures and statistical/fiscal information.

+ Interpret and apply complex policies, procedures, laws and regulations necessary to support the medical and/or legal issues of cases.

+ Working knowledge of Word, Excel and the basic computer programs used by Program Integrity and Oversight department.

+ Effectively communicate with persons involved in cases, minimizing conflict and de-escalating conflict should it arise.

+ Variety of experiences working effectively with others from different backgrounds and cultures.

Additional Requirements

Incumbent must possess and maintain a valid driver’s license.

This position requires successful completion of the following:

It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:

+ Criminal background check

+ Reference check

+ Fingerprinting check (MNJIS/CJIS)

Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3-business days from the start of employment; and successfully obtain/retain CJIS certification annually.

AN EQUAL OPPORTUNITY EMPLOYER

Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status.

Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email [email protected] . Please indicate what assistance is needed.