Claims Investigator

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.

Explore more details on the Benefits of Working at HHS webpage.

Functional

Title:

Claims Investigator

Job Title:

Investigator II

Agency:
Health & Human Services Comm

Department:
Benefits Program Integrity

Posting Number: 18365

Closing Date: 07/09/2026

Posting Audience:
Internal and External

Occupational Category:
Business and Financial Operations

Salary Range: $3,409.83 - $4,252.00

Pay Frequency:
Monthly

Salary Group: TEXAS-B-16

Shift: Day

Additional

Shift: Days (First)

Telework:
Eligible for Telework

Travel:
Up to 20%

Regular/Temporary:
Regular

Full Time/Part Time:
Full time

FLSA Exempt/Non-Exempt:
Nonexempt

Facility

Location:

Job Location City: EL PASO

Job Location Address: 401 FRANKLIN AVE

Other Locations:
El Paso

MOS Codes: ,,,8012,14N,14NX,183X,1D7X1,1N0X1,1S0X1,250X,311A,31A,31B,31D,31PX,351L

351M,35A,35L,35M,3E7X1,3P0X1,43HX,4B0X1,4E0X1,5I0,649X,683X,71SX,749X,783X,89D,89E,EOD,INV,IS,IV,LN

MA,ME,MLES,MSSD,MSSE,MSSR,MST,OAP
12,OAP
14

Brief

Job Description

The Office of Inspector General (OIG) Benefits Program Integrity (BPI) Claims Investigator II reports to the BPI unit manager/director. BPI Claims Investigators perform moderately complex investigative work regarding recipients of HHS programmatic services, such as Medicaid; the Children's Health Insurance Program (CHIP); the Supplemental Nutrition Assistance Program (SNAP);
Temporary Assistance for Needy Families (TANF); and the Women, Infants, and Children's (WIC) program. The BPI Claims Investigator III is responsible for investigating referrals of fraud, waste, and abuse by HHS clients; conducting thorough research and evidence gathering activities; and determining whether the information collected represents a violation of program laws, rules, or regulations according to applicable evidentiary standards.

The Claims Investigator II ensures that allegations of client fraud, waste, or abuse are investigated according to law, regulations, agency policies, and professional standards. The position reviews and analyzes records and reports from multiple agency, state, and federal databases; collaborates with both internal and external stakeholders to obtain verification and evidence; understands and applies relevant eligibility requirements; and calculates and establishes over payment claims.

The position obtains business records affidavits, submits subpoenas, and coordinates with law enforcement or other state and federal entities. The Claims Investigator may present cases at both Fair Hearings and Administrative Disqualification Hearings.

The position may assist with preparing and presenting training, suggest improvements to BPI's investigative processes to improve efficiency and promote program integrity, and perform other related duties as assigned. Works under general supervision with limited latitude for the use of initiative and independent judgment as governed by policy and procedures.

Essential Job Functions

30% Researches, conducts, collects evidence, reviews records, and examines potential eligibility discrepancies through multiple agency, state, and federal systems to determine program compliance and identify fraud. Interacts and exchanges information with various internal and external stakeholders; coordinates with law enforcement organizations and other state and federal agencies; and contacts and interviews witnesses and complainants as appropriate to verify recipient case information and evaluate allegations of fraud, waste, and abuse.

Follows HHS and OIG policies and procedures and adheres to applicable investigative standards and evidentiary protocols.

30% Evaluates, summarizes, and documents investigative findings and prepares detailed, factual investigative case reports. Calculates over payments and establishes over payment claims to recover unauthorized benefit payments. Prepares correspondence to clients detailing investigative outcomes and provides testimony and presents case file information and evidence at administrative hearings.

30% Maintains clear investigative documentation and implements well-organized electronic filing and documentation systems. Employs organizational techniques to manage a high volume of investigations at various stages simultaneously. Suggests process improvements that increase efficiency and effectiveness of investigative activities and documentation. Adheres to confidentiality requirements and records retention schedules.

10% Assists in preparing and delivering training, may assist with policy and procedure or job aid development and review, and may provide input into…