Income Maintenance Investigator II

The primary purpose of this position is to educate, prevent, discover and recover overpayments/over issuance related to fraud in cases of the income maintenance programs.  Work at this level requires reviewing clients’ case files and making decisions as to the appropriate action to take in resolving the case.  Employees determine if errors exist and, if so, the cause of the errors.  Investigators initially evaluate case referrals to determine if the referral is valid and whether a more in-depth review is required.  Where the cause of the error indicates potential client fraud, the worker is responsible for investigating the case and determining the appropriate course of action required to resolve the case.  Work also involves working with clients to settle cases out of court, representing the agency in negotiating out of court settlements, and developing and working with the prosecutor in presenting the case in court.   They also have a substantial involvement in the administrative hearing and judicial process and the recoupment of agency errors.  The investigator works with a considerable degree of independence investigating alleged fraud in programs operated by the Department of Social Services.

INVESTIGATION – (55%) The investigator is responsible for investigating cases of suspected fraud as a result of a recipient’s failure to report changes in their situation or because of the recipient’s willful withholding of information with the intent of receiving benefits to which they were not entitled. The investigation process consists of:

•  The investigator follows the fraud plan which has been approved by the Social Services Board. The investigator presents those cases recommended for prosecution to the District Attorney’s office and to the Grand Jury when appropriate. The investigator is responsible for working with the District Attorney and any other law enforcement agency necessary in representing the department of social services in cases suspected of fraud that are to be disposed of through the court system. The investigator is also responsible for the disposition, through the appropriate administrative procedures of cases that are not prosecuted.
• The investigator informs interested and concerned citizens of the various program policies to educate them and maintain program integrity. The investigator works with a variety of community contacts to fulfill the job duties/responsibilities.
• The investigator receives referrals of suspected program violations from agency staff, County Commissioners, anonymous phone calls, concerned citizens, ex-friends of the client in question, store managers or any member of the general public. The referrals are logged in a master log and disposed on by the investigator. The investigator is responsible for investigating any and all referrals received by the investigative unit regardless of the reason or basis of the referral.
• The primary source of referrals to the program integrity unit are through employees of the Department of Social Services.   Other referrals come from the general public, Community Agencies, IRS, Financial Resource Report (FRR) and the Beneficiary Earnings Exchange Report (BEER).  This position has a consistent caseload and is expected to be completed per policy guidelines.
• Supervisory sessions are conducted on a regular basis depending on the skill, training and expertise of the staff person. Supervisor, director or others are consulted when instruction/interaction/suggestions are needed for an individual case. The supervisor reviews all reports submitted, all letters requiring a signature and attends, on a random basis, interviews conducted with recipients.
• The Income Maintenance Investigator is part of a specialized fraud investigative initiative. Successful completion of public assistance fraud investigation requires a high degree of specialization. The investigator must develop a sound working knowledge of the public assistance programs, i.e., Food & Nutrition Services, Work First Family Assistance, Medicaid, Special Assistance, Daycare and Services.
• The investigator is responsible for reassessing eligibility in Food & Nutrition Services, Work First Family Assistance, Family and Children’s Medicaid, Adult Medicaid, State/County Special Assistance, Daycare and Service programs.                                     
• The investigator presents cases suspected of fraud to the District Attorney’s office and Grand Jury. During the presentation of cases to the District Attorney, questions sometimes arise in which the investigator must explain the different program policies according to the manual sections of the program in question. The investigator also testifies in court for cases prosecuted for suspected fraud.
•  Occasionally the investigator receives a referral as a result of a quality control review to investigate facts given by the client to a quality control reviewer that are not documented in the case record. The investigator must re-verify information that the quality control reviewer may already have verified, re-determine the amount of assistance, process the claim and take appropriate action. Also, corrective action plans are developed as a result of the quality control review that reveals errors in programs relating to client eligibility.

An Associate Degree in Human Services Technology, Social Services Associate, Paralegal Technology, Criminal Justice, Business Administration, Secretarial Science or closely related curriculum and two years of experience as an Income Maintenance Caseworker or Investigator; or, graduation from high school and three years of experience as an Income Maintenance Caseworker or Income Maintenance Investigator; or graduation from high school and two years of investigative experience in credit, legal, or law enforcement work plus eighteen months of experience as an Income Maintenance Caseworker or Income Maintenance Investigator; or an equivalent combination of training and experience.