Positions in this job family are assigned responsibility for conducting internal and external audits and field investigations and performing federally or state mandated quality control audits to evaluate the effectiveness of agency programs. Some positions will perform follow-up reviews and advocate for clients and program changes . Duties include investigating welfare fraud and employee violations of agency policy, regulations and applicable state and federal laws. Some positions in this job family will conduct investigations and inquiries to protect the rights of clients, act as client advocate and file grievances on behalf of clients.
The functions within this job family will vary by level, but may include the following:
Carries a caseload comprised of audits and investigations; analyzes and evaluates employee actions and programellectiveness or operations at the local level.
Verifies client compliance with agency regulations; contacts client and verifies essential information, such as income and benefits received by client; summarizes information and prepares case reports.
Reviews selected cases for eligibility for TANF, day care, food stamps and medical assistance; ensures completeness of documentation of eligibility factors; and ensures correctness of denial or termination of services.
Visits and reviews various types of contractors, including but not limited to, residential care providers, day care facilities to determine compliance with laws and regulations and to perform financial reviews; conducts assessments of state institutions and internal operations; reviews payments to contractors or grantees to ensure that funds were spent appropriately and that services were provided.
Investigates violation of Medicaid or other welfare programs and assignment agreements on the part of physicians, hospitals and other providers; position may refer potential fraudulent practices to appropriate law enforcement.
Acts a client advocate; protects rights of clients assigned to State Human Services or Juvenile Affairs facilities, or other state contracted providers, files grievances on behalf of clients.
Coordinates activities of a client grievance system, acts as client grievance facilitator and addresses allegations of client mistreatment, and may investigate. Monitors agency, facility, and contract provider policy and procedures, identifies policy violations and unauthorized practices, and recommends corrective action.
May conduct welfare fraud investigations; coordinates fraud investigation surveillance activities with other state and federal agencies; appears and testifies as a witness in a court trial; may perform investigations in the capacity of a certified police officer.
Performs field investigations regarding employee error rates, employee worker’s compensation cases and third party liability cases.
Preforms investigations on vulnerable children and adults in the areas of abuse, neglect, and exploitation in accordance with all state and federal laws.
Reviews and analyzes personnel actions and procedures for compliance with the Oklahoma
Personnel Act and Merit Rules for Employment; investigates alleged violations of personnel laws and regulations.
KNOWLEDGE, SKILLS, & ABILITIES
Knowledge of the rules and regulations governing social service agencies and residential facilities or contract providers; of quality control and audit procedures; and of review and investigative techniques. Ability is required to review and analyze large amounts of information and identify deficiencies; to conduct interviews effectively; to establish and maintain effective working relationships; and to communicate effectively, both orally and in writing.
Those required at level 1 plus the knowledge of the Oklahoma Personnel Act and Merit for for employment; and of organizational theory and function.
Those identified at Level II plus the knowledge of modern criminal and other investigative techniques; of computers and computer software. Ability is required to conduct multiple investigations, audits and/or reviews simultaneously; to gather and analyze evidence and information; to organize and present facts in a concise and objective manner; to testify in court; and to conduct interviews and interrogations.
Those identified at Level III plus the knowledge of Oklahoma law pertaining to crime, search and seizure, arrests and rules of evidence; of social welfare legislation as it pertains to the state administration of public welfare programs; and of supervisory principles and practices. Ability is required to effectively plan work and to supervise employees.
This job family consists of four levels which are distinguished by the level of complexity and diversity of the specific job assignments, the extent of responsibility assigned, the expertise required for the completion of the duties assigned and the responsibility assigned for providing leadership to others.
This is the basic level where employees perform routine audits and investigations and receive training in policy and procedures pertaining to the performance of difficult and complex audits and welfare fraud investigations. Employees work closely with higher level inspectors and will attend training sessions to acquire necessary skills, investigations on abuse, , neglect, and exploitation to vulnerable persons, or manage a caseload to ensure the protection of the rights of vulnerable person with intellectual disabilities. At this level employees carry a routine caseload of audits and investigations; prepare material pertinent to the analysis and evaluation of program operations at the local level; and analyze records to determine completeness of documentation. Employees will receive training regarding the investigation of persons suspected of welfare fraud or abuse, neglect and exploitation ; assist higher level Inspectors in fraud investigations and surveillance activities; secure, analyze and assemble pertinent information pertaining to cases filed by the District Attorney, local law enforcement or other legal authority; appear and testify, if subpoenaed, as a state witness in a court trial; may perform investigations in the capacity of a certified peace officer.
Additional duties at this level include investigating client grievances, acting as client advocate, and reviewing routine cases for investigative or audit purposes in the areas of eligibility for TANF, day care, food stamps and medical assistance, or other welfare programs for vulnerable persons; reviews routine cases for correctness of denial or termination of TANF, food stamps and medical assistance, submits review for federal re-review or audit. Audits nursing homes, hospitals, physicians, day-care centers, state facilities, contract providers, and pharmacies to determine compliance with state and federal regulations; evaluates findings, makes recommendations for correction of noncompliance; assembles case findings; and compiles all information into reports which are submitted to higher level Investigator/Auditors for review and determination of appropriate action.
At this level, employees are assigned responsibilities at the full performance level. In addition to the duties performed at Level I, tasks will include, but are not limited to, carrying a caseload of complex and difficult audits and investigations; preparing material pertinent to the analysis and evaluation of program operations at the local level; analyzing records of selected cases in all counties to determine completeness of documentation of eligibility factors and implementation by the agencies; and analyzing plans for caseworker service. Documents all eligibility factors on cases selected for review. Coordinates fraud investigation surveillance activities with other state and federal agencies, assists out-of-state agencies in investigations; may conduct single suspect investigations; may perform investigations in the capacity of a certified peace officer. In addition, employees at this level review and analyze personnel actions and procedures for compliance with the Oklahoma Personnel Act, Merit Rules for Employment and internal agency policies and regulations, investigate alleged violations of personnel laws and regulations, evaluate findings and prepare reports, make recommendations for correction of noncompliance. Locate and conduct interviews with selected recipients; check collateral references for verification of essential information pertinent to the case under review; verifies income and other benefits received by client household; summarizes results of investigation and/or reviews conclusions of case review; prepares weekly and monthly reports to supervisor. Employees will also investigate violations of Medicaid programs and assignment agreements on the part of physicians, hospitals and/or other providers and investigate complaints against the juvenile service system.
This is the specialist level where employees are assigned responsibilities of difficult and complex investigations and audits, lead worker or investigator, mentor, or back-up supervisor. In addition to the duties performed at Level II, tasks will include, but are not limited to, multiple suspect investigations, audits or reviews. Cases and/ or audits assigned to this level employee are multifaceted and may include several levels of investigation, audit and/or review. This level employee requires minimal supervision. Employees may complete investigations, perform quality control reviews or conduct audits to evaluate the effectiveness of program operations. Employees at this level may participate in research and development of computerized investigation/audit programs to aid in the work of the unit or division.
This is the leadership level where incumbents provide direct supervision of lower level staff. Responsibilities may include assignment of investigations and audits to lower level staff; performing advanced reviews, audits and investigations; and conducting investigations of alleged fraudulent activities in connection with violations of policy, procedure or law. Employees at this level will serve as supervisor and train and advise subordinate staff in the review, evaluation and investigation of program operations at the local level; assign work of lower-level staff; conduct staff meetings to discuss results of audits and investigations; direct compilation of information and the preparation of audit and investigative reports. In addition, employees will plan, develop, supervise and coordinate investigations which may require acting in the capacity of a certified peace officer; audit and review documentation for program compliance within agency areas, direct surveillance activities in connection with fraud investigations and serve as a member of an inner-office review team. Assemble case and investigative findings and compile all information into reports to be made to appropriate division personnel for action.
Education and Experience requirements at this level consist of a bachelor’s degree and two years of professional experience in investigation, auditing, social work, juvenile justice, personnel administration, law enforcement, child support enforcement, or working with person with intellectual disabilities; or an equivalent combination of education and experience.
Education and Experience requirements at this level consist of those identified in Level I plus one additional year of qualifying experience.
Education and Experience requirements at this level consist of those identified in Level II plus one additional year of qualifying experience.
Education and Experience requirements at this level consist of those identified in Level III plus one additional year of qualifying experience.
Applicants for some positions within the Department of Human Services will be required to possess necessary qualifications to be a Qualified Mental Retardation Professional as defined in the Conditions of Participation for Intermediate Care Facilities for the Mentally Retarded, Code of Federal Regulations, Subpart D, 42 CFR 483.430 (a) and (b)(5).
Some positions may require current certification by the Oklahoma Council on Law Enforcement Education and Training as a peace officer.
Some positions may require two years in quality control, auditing or the investigation of abuse, neglect, or exploitation, fraudulent activities in connection with Medicaid or social services programs, or criminal investigations at levels III and IV.
Applicants must be willing and able to fulfill all job-related travel normally associated with this position.
CLASS: H22A; EST: 8/22/2007; REV: 7/2/2012 7:45:00 AM;
CLASS: H22B; EST: 8/22/2007; REV: 7/2/2012 7:45:00 AM;
CLASS: H22C; EST: 8/22/2007; REV: 7/2/2012 7:45:00 AM;
CLASS: H22D; EST: ; REV: 7/2/2012 7:45:00 AM;