General Overview
Under general supervision, investigates complaints and allegations of fraud, forgeries, and other crimes associated with federal and State of Ohio mandated programs. Initiates collateral and client contacts to compile information. Secures verification’s and evidence. Conducts in-house investigations to substantiate allegations of fraud and prepares case for prosecution upon establishment of proof of fraud. Ensures all case evidence and eligibility calculations are well documented, complete, organized, accurate, and completed timely to meet M.E. Review guidelines and all compliance mandates. Maintains database of collateral and investigative contact sources and resources. Prepares and maintains records, statistics, reports, and other documentation. Performs other related duties as requested, directed, or assigned.
Required Qualifications
QUALIFICATIONS OR EQUIVALENT COMBINATIONS OF TRAINING AND/OR EXPERIENCE:
Completion of secondary education, supplemented by college-level course work or training in criminal justice and investigation techniques, plus six (6) months investigative experience, or equivalent combination of training and/or experience.
Licensing/Certification

• Possession of valid driver’s license, if utilization of a motor vehicle to perform the essential functions is required.
• Must maintain current certifications, licenses.
• Must attend program eligibility training, benefit recovery training, and any other applicable training as directed by management.
• Meet and maintain eligibility requirements for bonding.

Job Duties
Investigative Functions
Investigates cases of known or suspected violations of the law related to the fraudulent receipt of welfare funds; *responds to complaints and/or suspected fraud; *gathers documentation and evidence, and/or conducts interviews to gather data; *`traces and locates suspects and witnesses; contacts employers, law enforcement agencies, and other public and private entities to secure and verify information related to fraud; *performs investigation case management planning to comply with state and federal guidelines; *researches and reviews reports, records and documents to verify information provided; *interviews suspects and witnesses and analyzes their testimony to determine allegations of fraud or forgeries of welfare benefits; prepares comprehensive, factual reports of all investigative activities and all evidence gathered and/or recommendations and submits preliminary information gathered to supervisor; reports progress of investigation; reviews client financial records and salary histories for determination of fraud and any other associated crimes such as forgeries, perjuries, and grand theft; *confers with defendants and attorneys to secure restitution of overpayments and fraudulently received funds; *conducts in-house investigations by gathering information, evidence and verifications to prove or disprove allegations of program fraud (e.g. review of agency and state automated systems CRIS-E, Document Imaging, Ohio BMV, The Work Number website, Innerweb Fraud Control website, Internet, and other information sources, and evidence from collateral contacts including, employers, tax preparers, financial and medical institutions, local, state and federal agencies via subpoena, fax, telephone, and email); *creates budget worksheets; *inputs financial data into Automated Budget and Claims Updating System (ABACUS); *determines correct benefit level using state and federal rules, regulations, policies and procedures to calculate overpayment/overissuance amounts for benefit recovery purposes; *enters results of investigation into CRIS-E Benefit Recovery System; *issues repayment notices and repayment agreements; *reduces benefits to apply to overpayment balances; *enters case results into overpayment table; *prepares documents and interviews client(s) to initiate program disqualification for Intentional Program Violations; *determines if overpayment was caused by agency/household error and takes necessary actions; *determines if claim is a potential intentional program violation; * pursues collection of overpayment/overissuance, or refers intentional fraud violation to County Sheriff and/or Prosecutor for prosecution with supporting evidence and necessary documents after proof of fraud has been established; *prepares data to be utilized by the County Prosecutor; *prepares documentation for an administrative hearing as required; responds to and processes BV alerts; *represents the agency in state hearings by presenting the case findings, evidence, and answering questions of State Hearing Officer and/or the client(s); *provides quality customer service by responding to client inquiries via telephone, walk-ins, and scheduled face to face interviews (e.g. explains overpayment notices, budget computations, and repayment arrangement options); *determines cause of overpayment, overpayment timeframe, applicable compliance mandates, action warranted, and case management’s need of information; *researches, secures and prepares verifications, evidence, and data for criminal prosecution of allegations of fraud ; *contacts law enforcement agencies to determine eligibility or overpayment of claims for benefit; *contacts child support agencies to obtain data related to the client/claims; *subpoenas client employers to obtain data about clients; *verifies information and consults with other agency units, federal, state and county agencies, local contacts, utility companies, hospitals, etc.; *prepares data to be utilized in the calculating of verifiable fraud or non-fraud overpayments; *researches regulations to ensure time frames are met; *obtains income data, shelter cost and other related documentation to determine the claim; *monitors overpayments to ensure compliance with established time frames; *notifies client if claim overpayment is due to agency/household error; *reduces benefits based on repayment agreement and an open case; *places the client who fails to respond to agreement on an automatic reduction; *prepares and attends overpayment reduction hearing; *monitors repayment plan to ensure client adheres to payment schedule; *conducts field investigations of suspected fraud after determining appropriateness of referral; *conducts field visits to verify case information; *initiates collateral and client contacts; *secures verifications and evidence; *works with caseworkers, supervisors, other agency staff and investigators, governmental agencies, public and/or private sector entities; *researches, secures and prepares data to be utilized in potential fraud allegations; *consults and collects information through contacts with other governmental agencies and/or public or private sector entities; *researches case histories and other public records to determine prior misuse of assistance; *works with caseworkers, supervisors, other agency staff and investigators; may assist other investigators; *receives possible cases of frauds; *conducts investigations of suspected fraud after determining appropriateness of EDP referral; *collects and analyzes evidence of alleged fraud; *initiates collateral and client contacts; *consults with other assistance agencies (e.g. interstate, intrastate, federal, state, local, etc.); *researches client case histories and related public records; *conducts house visits to obtain additional facts related to the allegations; *secures verifications and evidence; *works with caseworkers, supervisors, other agency staff and investigators; *recommends actions based on facts and data obtained by investigation; *prepares documentation for additional actions that may be taken; assists with special projects as needed; *monitors corrective action to ensure compliance.
Denotes essential functions of the job.
Documentation and Correspondence Functions
Creates and maintains collateral and investigative contact source and resource database; *prepares and submits documentation generated (e.g. reports, memos, history updates, etc.); *maintains complete, clear, concise and accurate case information to comply with Management Evaluation (M.E.) review guidelines; *documents case activities, scans files into Document Imaging; *contacts providers and agency staff to update them and affected entities on investigative status; *maintains accurate records and files; *compiles and maintains statistical records and case files, weekly and monthly reports and analyses; prepares and responds to correspondence; *maintains case files and ensures decisions are communicated to affected work units.
Denotes essential functions of the job.
Other Functions
Provides quality customer service by assisting clients, agency staff, community agencies, medical providers, governmental agencies, and service providers in resolving inquiries, complaints, or problems; *presents self in a professional, ethical and culturally sensitive manner to co-workers, staff, other agency personnel, clients, partners, and the public; *adheres to all policies and procedures (e.g. division, agency, county, federal and state); *attends meetings, conferences, workshops, seminars and training to remain current and knowledgeable on agency, provider, and program rules, policies, regulations, procedures and to receive information on available resources and eligibility requirements as directed; *demonstrates regular and predictable attendance.
Denotes essential functions of the job.