Description

Job Purpose: This position is responsible for analyzing processes, incident reporting, communications, and referrals from other sources for program integrity measures and triggers. The position will manage and/or facilitate referrals for suspected fraud, misuse, waste, and abuse within privately and publicly funded program rules. The Program Integrity Specialist interfaces with clients, government, and law enforcement agencies to ensure program integrity within the Fiscal, IRIS, and/or client payroll processes. This position will also support projects based on business needs and caseload in queue. Project support can include but is not limited to data collection, data analysis, reporting data, and creating project materials as needed.

Reporting Relationships

Reports To: Quality Supervisor

Direct Reports: None

Essential Job Functions:

(Reasonable Accommodations may be made to enable individuals with disabilities to perform these essential functions.)

1. Identify, analyze, investigate and evaluate moderate to complex potential fraud, waste, or abuse, including pre-pay and/or post-pay claims reviews to determine validity for referral; document findings, and prepares supporting documentation and reports.
2. Conduct, collect, review and analyze documents, statements, interviews, financial records and information pertaining to an allegation of fraud.
3. Document case activity and fund allocation in a database of allegation data and fraud case information for timely retrieval and analysis and conduct follow-up-actions in a timely manner following documented departmental guidelines.
4. Reconcile documents in conjunction with payroll, to include but not limited to: court orders, budgets, and employee and employer documentation.
5. Establish and maintain contractual relationships with our funders, law enforcement agencies, external program agencies and customers.
6. Act as the primary iLIFE subject matter expert in designated judicial and/ or court system hearings as it pertains to Fiscal, IRIS, and/or client payroll processes.
7. Collect, analyze, audit and maintain compliance for all Program Integrity related forms, processes, and reporting requirements.
8. Develop and regularly review program integrity reports to detect suspected trends or triggers for additional review and facilitate mitigation strategies for long-term monitoring and corrective action.
9. Advise program workers victimized by identity theft or worker fraud.
10. Conduct necessary education/training relating to fraud, waste or abuse to internal staff and external stakeholders as needed.

Required Education, Experience, Certifications, Licensure and Credentials: (Where appropriate, education and/or experience may be substituted)

Minimum Required Education: Associates Degree or higher in business/accounting preferred, or an equivalent combination of training and experience which will provide the necessary knowledge, skills and abilities.

Minimum Required Experience: 2 years professional experience in any of the essential job functions listed above

Required License Certification Registration: N/A

Issued By Governing Body (if applicable): N/A

Travel outside of office: 10% travel if there are in-person hearings

Required Valid Driver’s License: Valid Wisconsin driver’s license.

Required Auto Insurance[SB1] : vehicle liability insurance in accordance with Agency policy if driving own vehicle

Qualifications

Knowledge Skills Abilities:

• High degree of integrity
• Strong organizational skills and prioritization skills for multiple investigations, projects and responsibilities
• Exceptional attention to detail
• Experience conducting audits and/or investigations in a professional setting
• Understanding and application of programmatic policies, procedures, work instructions and regulations
• Comfortable working with our funders, law enforcement agencies, external program agencies and customers
• Experience preparing/presenting oral and written reports
• Ability to work mostly independently but also as a team
• Ability to mediate and deescalate disputes
• Problem solver
• Mathematical Reasoning
• Accountable & dependable

Physical Requirements, Visual Acuity, and Work Conditions:

Physical Requirements: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Visual Acuity: The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal.

Working Conditions: None: The worker is not substantially exposed to adverse environmental conditions.