Fraud investigator Job at California Department of Health Care Services, Los Angeles, CA

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  • California Department of Health Care Services
  • Los Angeles, CA

Job Description

Job Description And Duties

Job Description and Duties

Why Join DHCS?

The Department of Health Care Services (DHCS) is the backbone of California ' s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies , counties, and partners for the care of low-income families , children, pregnant women, older adults, and persons with disabilities . This is an exciting opportunity to join our diverse team in the following role . If you are interested in joining our team, apply today!

About this Role:

Under the general direction of the Supervising Fraud Investigator II : Functions as a working supervisor and directs a team of investigators responsible for coordinating and conducting sworn and non-sworn background investigations for Peace Officer Investigations Branch (POIB) applicants. The Supervising Fraud Investigator I (SFI I) may be assigned internal affairs or special investigations as directed by the Chief. Responsible for analyzing current policy, new legislative mandates, case law and best practices to make policy updates/ recommendations to the Chief, writing and revising policy & procedure through Lexipol. The SFI I is a sworn peace officer position who oversees, and may perform, the full range of peace officer duties and responsibilities in the course of their work. Completion of the POST Supervisory Course within one (1) year from date of appointment to Supervising Fraud Investigator I. Travel of up to 15% is required and overnight stays may be required.

If you are interested, please submit a Standard State Employment Application From (STD 678). Applications will be screened and only the m ost qualified candidates will be interviewed. Failure to complete the STD 678 in its entirety may result in disqualification.

Electronic applications are highly encouraged.

This recruitment has been posted for more vacancies than currently exist as it may be used to fill additional identical vacancies which occur within 180 days of the closing date of this bulletin.

If you are interested in this position, it is critical to review the Classification Specification to determine if you will meet the minimum qualifications (MQs). Please make note of Education and Experience requirements for the classification. The Classification Specification and MQs can be found in the Minimum Qualifications section below.

Please see attached duty statement

You will find additional information about the job in the Duty Statement .

Working Conditions

Below are the options Department of Health Care Services - Audits & Investigations offers incumbents:

  • Regular or recurring telework may occur as part of the incumbents ongoing regular schedule per DHCS’s Telework Policy, in accordance with Government Code Sections 14200 – 14203 for employees residing in California.
  • Telework stipends are currently available
  • State issued vehicle and phone
  • Flexible work schedules
  • Training & Development opportunities
  • Bilingual (B) Candidates will have an opportunity to receive bilingual pay of $100 a month for employees; contingent they meet CalHR requirements


Minimum Requirements You will find the Minimum Requirements in the Class Specification.

  • SUPERVISING FRAUD INVESTIGATOR I, DEPARTMENT OF HEALTH CARE SERVICES


Additional Documents

  • Job Application Package Checklist
  • Duty Statement


Position Details

Job Code #:

JC-455794

Position #(s):

806-309-8065-XXX

Working Title:

Supervising Fraud Investigator I

Classification:

SUPERVISING FRAUD INVESTIGATOR I, DEPARTMENT OF HEALTH CARE SERVICES

$8,152.00 - $11,142.00

# of Positions:

Multiple

Work Location:

Los Angeles County

Telework:

Hybrid

Job Type:

Permanent, Full Time

Department Information

DHCS is California’s health care safety net, helping millions of low-income and disabled Californians each and every day.

DHCS' purpose is to provide equitable access to quality health care leading to a healthy California for all. To accomplish this, DHCS finances and administers state and federal health programs, including medical, dental, mental health, substance abuse treatment services, and long-term care. We work hard every day to fulfill our vital responsibility to support the delivery of quality health care to Californians.

DHCS is a dynamic department with ambitious goals and talented, committed employees. We work hard every day to fulfill our vital responsibility to support the delivery of quality health care to Californians.

DHCS is committed to addressing disparities with our organization and in our communities through efforts toward greater diversity, equity, and inclusion. This is accomplished, in part, by a commitment toward employing a diverse workforce which reflects the many communities we serve, and by promoting and enforcing equal employment opportunities.

Audits and Investigations (A&I) is the designated Program Integrity Unit for California’s Medicaid program – Medi-Cal. A&I’s mission is to protect and enhance the integrity of the health programs administered by DHCS. To carry this out, A&I performs financial and compliance audits, including post-service post-payment utilization reviews, of Medi-Cal providers; performs compliance and med ical audits of medical, dental and behavioral health managed care plans; identifies and investigates Medi-Cal provider and beneficiary fraud, waste, and abuse, emphasizing fraud prevention; ensures accountability of state and federal health care funding by recovering identified overpayments; performs onsite reviews as part of the Medi-Cal provider enrollment process; provides technical assistance (financial and medical) for the development and enhancement of DHCS health programs and related policy; and provides technical assistance and audited data to support health care financing initiatives and objectives such as provider rate setting.

Investigations Division (ID) conducts administrative and criminal investigations pursuant to the statewide Medi-Cal and other DHCS programs’ fraud, waste, and abuse investigative program. Specific activities include fraud data analytics, Medi-Cal fraud Hotline and complaint intake, investigative audits, provider fraud investigations, and beneficiary fraud investigations.

A&I is seeking a candidate to join as a Supervising Fraud Investigator I. Please direct all questions to the hiring unit contact listed in this job posting.

Special Requirements

The position(s) require(s) a valid California Drivers License (CDL). You must answer the questions addressing your CDL on your application. Ensure you provide your CDL number, class, expiration date, and any endorsements and/or restrictions.

The position(s) require(s) a Background Investigation be cleared prior to being hired.

The position(s) require(s) Medical Clearance prior to being hired.

The position(s) require(s) Psychological Evaluation clearance prior to being hired.

Supervising Special Investigator I Exam

Application Instructions

Completed applications and all required documents must be received or postmarked by the Final Filing Date in order to be considered. Dates printed on Mobile Bar Codes, such as the Quick Response (QR) Codes available at the USPS, are not considered Postmark dates for the purpose of determining timely filing of an application.

Final Filing Date: 11/14/2024

Who May Apply

Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list or LEAP eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available). SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the event no SROA or Surplus candidates apply.

Applications will be screened and only the most qualified applicants will be selected to move forward in the selection process. Applicants must meet the Minimum Qualifications stated in the Classification Specification(s).

How To Apply

Complete Application Packages (including your Examination/Employment Application (STD 678) and applicable or required documents) must be submitted to apply for this Job Posting. Application Packages may be submitted electronically through your CalCareer Account at When submitting your application in hard copy, a completed copy of the Application Package listing must be included. If you choose to not apply electronically, a hard copy application package may be submitted through an alternative method listed below:

Address for Mailing Application Packages

You may submit your application and any applicable or required documents to:

Department of Health Care Services

Mailing

Attn: Certification Technician

M.S. 1300

P.O. Box 997411

Sacramento , CA 95899-7411

Address for Drop-Off Application Packages

You may drop off your application and any applicable or required documents at:

Department of Health Care Services

Drop-Off

1501 Capitol Avenue, Suite 71.1501

Sacramento , CA 95814

08:00 AM - 05:00 PM

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

  • Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
  • Resume is required and must be included.
  • Statement of Qualifications - A Statement of Qualifications (SOQ) is required. The SOQ serves as documentation of each candidate’s ability to present information clearly and concisely in writing. The SOQ is not a resume or cover letter. Resumes and/or Cover Letters DO NOT take the place of the SOQ. Applications received without an SOQ may not receive further consideration and may be excluded from the hiring process.


Failure to submit a Statement of Qualifications, or failure to follow the instructions may result in your disqualification. In up to two pages (12 point, Arial font), respond to the following questions.

  • Describe how your experience and education has prepared you for this position.


Applicants requiring reasonable accommodations for the hiring interview process must request the necessary accommodations if scheduled for a hiring interview. The request should be made at the time of contact to schedule the interview. Questions regarding reasonable accommodations may be directed to the EEO contact listed on this job posting.

Benefits

Benefits

The state offers comprehensive benefits for its employees, who provide essential and exceptional service to millions of Californians every day.

  • Health, Vision and Dental
  • Retirement
  • Savings Plan
  • Group Legal Service Insurance
  • Vacation/Annual Leave Accrual
  • Paid Holidays
  • Employee Assistance Program


Benefit information can be found on the CalHR and CalPERs websites.

In addition, DHCS – Audits & Investigations offer:

  • Training opportunities to support role
  • Upward Mobility


Contact Information

The Hiring Unit Contact is available to answer questions regarding the position or application process.

Hiring Unit Contact:

Larry Lising

(213) 294-3662

Larry.Lising@dhcs.ca.gov

Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.

EEO Contact:

EEO Officer

(916) 440-7370

civilrights@dhcs.ca.gov

California Relay Service: 1-800-735-2929 (TTY), 1-800-735-2922 (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.

Additional Information

Using the online application system as specified in the announcement is the preferred method of applying for civil services job

opportunities; however, applicants may instead apply by way of U.S. mail, parcel delivery or courier service, or in person, as set forth in this announcement. Paper applications must include a signature. Dates printed on envelopes by mobile barcodes or equivalent mobile print technology

are not acceptable proof of the date the application and any other required documents or materials were filed. A completed state application (STD. 678) and any documents list under “Required Application Documents” must be submitted with your application package. Applicants who are relying on additional documentation (e.g., transcripts, copy of degrees, certifications, licenses, etc.) in order to prove that they meet the minimum qualifications listed in the Classification Specification (located on the right under

“Additional Documentation) must submit those documents with their application package. Failure to submit these documents may result in

your application being disqualified. Applications must include a description of the duties performed for each position held; reference to a

resume in place of a description of the duties performed will not be accepted.

Applicants must state their basis of eligibility (List Eligibility, Lateral Transfer, Reinstatement, T&D, or Surplus/SROA), and the Job Control

(JC) number and/or position number in the “Examination(s) or Job Title(s), For Which You Are Applying” section on the STD. 678.

Surplus/SROA candidates should submit a copy of their letter with their application. Please remove any confidential information (i.e.

social security number, date of birth, etc.) as well as any information regarding your LEAP eligibility and/or exam scores from

your documents prior to submission.

Equal Opportunity Employer

The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.

Job Tags

Holiday work, Permanent employment, Full time, Remote job, Flexible hours, Night shift,

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