Maintenance Investigator

Job Summary

This position is primarily responsible for investigation of alleged fraud in the income maintenance programs of Social Services and conducting front-end investigations on applications for assistance. This will include home visits. Work at this level requires the review of income maintenance case files referred to them by income maintenance caseworkers and supervisors or where fraud allegations are made by individuals within the community to determine whether errors exist and, if so, the cause of errors.

Where the cause of error indicates potential client fraud, the worker is responsible for investigating the case, meeting with the client to discuss the situation, and offering to enter into a repayment agreement or a reduction of benefits. The investigator makes recommendations concerning the appropriate action to take in resolving the cases. Employees may assist in presenting the case or assist the District Attorney in the prosecution of the client in court.

Other duties may be assigned. Competence in computer skills with Microsoft Office Professional is required.

• Respond to allegations of fraudulent application for public, medical, or food and nutrition assistance from the general public, caseworkers, law enforcement officials, and other community and governmental agencies; researches and compiles information relating to case.
• Interviews clients filing allegedly fraudulent applications and other parties who may have relevant information concerning investigations such as neighbors, employers, or landlords.
• Makes decisions and determines disposition of investigative cases.
• Makes arrangements with the client for repayment of assistance if it was erroneously applied for without fraudulent intent and when fraudulent action is determined in hearing decisions.
• Arranges administrative fraud hearings with a hearing officer for clients alleged to have had fraudulent intent in applying for assistance; presents documents and testifies at hearings.
• Establishes a collection record when over payment or over-issuance occurs; monitors claims for collection status; utilizes many different methods and sources for collection activity including garnishments, tax intercept, and small claims court.
• Serves as program consultant and technical advisor to the eligibility staff, reviewing over payment/underpayment errors to reduce the occurrence of program violations and errors.
• Prepares and submits Medicaid facility/provider over payments to the state for processing.
• Consults with departmental attorney and Social Services Board about referral of fraudulent actions to courts; draws and files warrants; testifies in court; assists District Attorney with prosecution.
• Maintains a variety of records; prepares a variety of reports.
• Performs Income Maintenance Caseworker II duties including interviewing, processing applications, eligibility redeterminations, and may maintain a small caseload or temporarily be responsible for a caseload for position vacancies.
• Documents case records; maintains records, files, and confidentiality.
• Gathers and reviews household income, financial resources, and residency data.
• Computes amounts of assistance for programs; adjusts underpayments.
• Completes replacement benefits for disaster/non-disaster incidents.
• Enters and retrieves data from the appropriate state and county systems.
• Produces monthly financial reports; searches documents for posting errors.
• Operates computer, scanner, calculator, and other standard office equipment incident to maintaining records.
• Participates in ongoing training as required.
• Participates in teams, taskforces, committees, job fairs, off‑site applications and outreach activities as assigned.
• Ensures all federal, state, and local policies and procedures are followed.
• Thorough knowledge of the program area(s) of assignment and of the federal, state, and county rules and regulations governing eligibility for assistance under various programs.
• Knowledge of investigative procedures and techniques and of administrative hearing procedures.
• Knowledge of and ability to read, analyze, interpret, and apply federal, state, and county program rules, regulations, and…