Investigator III

Job Responsibilities

The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians.

This position is located in Medical Service & Ancillary Review, Richland County.

This is an in-office role and not a telecommute or remote position.

Are you the One? We are looking for an Investigator III who conducts investigations to ensure compliance with South Carolina Department of Health and Human Services (SCDHHS) policies, state statutes, and regulations. Conducts routine to complex sensitive investigations of Medicaid providers and beneficiaries or any reported fraudulent violation of the Medicaid program. Works with various officials and agencies on the local, state, and federal levels concerning related investigations.

Assists the Office of General Counsel in coordination of witness testimony as needed at administration hearings.

• Conduct confidential and comprehensive investigations on provider cases and complaints to ensure compliance with South Carolina Department of Health and Human Services (SCDHHS) policies, state statue, and regulations.
• Interviews Medicaid beneficiaries, providers, and/or other witnesses to gather facts relating to potential Medicaid fraud and abuse. Prepares onsite investigative report at time of onsite review. Prepares interview summaries of Medicaid beneficiaries when interviewed.
• Use Medicaid Management Information Systems (MMIS), Citizen Law Enforcement Analysis and Reporting (CLEAR), IFLOW, SAS Analytics, OnBase, and other investigative tools as necessary to aid in conducting research on providers.
• Perform case reviews and provider referrals. Give timely and proper disposition to assigned complaints.
• Ability to testify at administrative and court hearings resulting from provider investigations.

The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

A high school diploma and experience conducting investigations.

A bachelor's degree may substitute for the required work experience.

• Occasional overnight travel.
• Requires holder to drive routinely.
• Sitting or standing for long periods of time.
• Lifting Requirements: 30 lbs.
• Valid driver’s license
• In-office Role

• Experience in Medicaid or Medicare fraud and waste investigations, healthcare fraud investigations, or in the Special Investigations Unit (SIU) of a managed care organization (MCO).
• Knowledge of the laws, rules, and regulations applicable to the job.
• Knowledge of investigative techniques, principles, and practices.
• Ability to evaluate evidence and conduct investigations.
• Ability to analyze facts and reach sound conclusions.
• Ability to present clear, concise, and comprehensive written and oral reports.
• Ability to establish and maintain effective working relationships with officials, attorneys, witnesses, and the general public.
• Ability to plan, organize and direct investigative programs.
• Ability to maintain confidentiality.

The established hiring range for this position is $45,300 to $55,000.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.

Eligible employees may enroll in health insurance, which includes prescription coverage and wellness benefits. Other available insurance benefits include dental, vision, term life insurance, long term disability and flexible spending accounts for health and child care expenses.

State employees are also offered retirement plan options, including defined benefit and defined contribution plans. Additionally, eligible employees may elect to participate in the South Carolina Deferred Compensation Program, which is a voluntary, supplemental retirement savings plan offering 401(k) and 457 plan options.

State employees may also be eligible for other benefits, including tuition assistance; holiday, annual and sick leave; and discounts on purchases, travel and more.

The benefits above are available to most state employees, with the exception of those in…