Senior Investigator - Pharmacy / Human Services Program Representative 2

Working Title: Senior Investigator - Pharmacy

Job Class: Human Services Program Representative 2

Agency: Human Services Dept

• Job ID: 90721
• Location: St. Paul
• Telework Eligible: Yes
• Full/Part Time: Full-Time
• Regular/Temporary: Unlimited
• Who May Apply: Open to all qualified job seekers
• Date Posted: 12/09/2025
• Closing Date: 12/22/2025
• Hiring Agency/Seniority Unit: Human Services Dept / MAPE DHS Central Office
• Division/Unit: Department of Human Services (DHS) / Office of Inspector General (OIG)-PIO MPAI Investigators 3
• Work Shift/Work Hours: Day Shift / 8:00 a.m. - 4:30 p.m.
• Days of Work: Monday - Friday
• Travel Required: Yes
• Salary Range: $32.40 - $47.76 / hourly; $67,651 - $99,722 / annually
• Classified Status: Classified
• Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE
• FLSA Status: Nonexempt
• Designated in Connect 700 Program for Applicants with Disabilities: Yes
  
  

The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.

The work you'll do is more than just a job.

At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.

• This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.
• Approximately, 10% travel.
  
  

This position exists to provide health, accounting, law enforcement and/or criminal justice system experience to combat waste, mismanagement, misuse, fraud, and abuse in the Minnesota Medical Assistance program. The employee will function independently and as a member of an investigation team, in training, developing and implementing strategies toward fraud detection, comprehensive investigations, and the development of cases that may involve civil, monetary, or criminal case actions. In addition, the employee will plan, develop, and implement strategies that are designed to minimize the opportunities for program abuse.

The position requires the employee independently investigate and assist other investigative staff to initiate, develop, and resolve cases which lead to administrative actions, sanctions, referrals for criminal action, and/or monetary recoveries of county, state and federal funds erroneously or fraudulently received by providers or medical services to clients of Medical Assistance. These functions are the major responsibilities of this position.

Minimum Qualifications

• To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.**
  
  

Three (3) years of experience reviewing and/or submitting pharmacy claims to the Minnesota Medical Assistance program.

AND

Experience must demonstrate the following:

• Registered Pharmacist with the Minnesota Board of Pharmacy or a Certified Pharmacy Technician with the Pharmacy Technician Certification Board.
• Experience with claims analysis, audits, or healthcare investigations.
• Develop audit approaches, chart reviews or verification checks for use in evaluating data to identify cases needing further review.
• Analyze fiscal and/or statistical data and identify discrepancies, claim patterns, and trends.
• Working knowledge of relevant state pharmacy laws, NCPDP billing standards, DEA rules, and/or third-party payor responsibilities.
  
  

Preferred Qualifications

• Broad-based, comprehensive understanding of federal and state health care policy, rules, laws and requirements that allow for making and/or denying payment of claims adjudicated the Medicaid claims processing system.
• Understanding of claims the processing operations, claims forms, edits and coding structures sufficient to be able to understand the procedures followed and decisions made by claims processing staff.
• Experience in retail, specialty, or long-term care pharmacy operations.
• Knowledge of medical terminology and coding.
• Presenting concise, well-written, factual, investigative reports, referrals, and other materials for legal review and consideration in civil or criminal cases.
• Some working knowledge of Word, Excel and the basic computer programs used by MPAI.
• The ability to learn the data warehouse and other analytical tools.
• Effectively communicate with persons involved in cases, minimizing conflict and de-escalating conflict should it arise.
• Writing legal and technical documents, i.e., Notices of Agency Action, correspondence, policies, procedures and statistical/fiscal information.
• Variety of experiences working effectively with others from different backgrounds and cultures.
  
  

Additional Requirements

This position requires successful completion of the following:

It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:

• Criminal background check
• Reference check
• Fingerprinting check (MNJIS/CJIS)
  
  

Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3-business days from the start of employment; and successfully obtain/retain CJIS certification annually.

How To Apply

Select “Apply for Job” at the top of this page. If you have questions about applying for jobs, contact the Careers Help Desk at 651-259-3637 or email careers@state.mn.us. For additional information about the application process, go to http://www.mn.gov/careers.

Contact

If you have questions about the position, contact Melanie LaBrie at melanie.labrie@state.mn.us.

To receive consideration as a Connect 700 Program applicant, apply online, email the Job ID#, the Working Title and your valid Proof of Eligibility Certificate by the closing date to Carolyn Rice at carolyn.rice@state.mn.us.

If you are an individual with a disability and need an ADA accommodation for an interview, you may contact the Department of Human Services’ ADA Coordinator at 651-431-4945 or DEPARTMENT OF HUMAN SERVICES_ADA@state.mn.us for assistance.

About Human Services Dept

WE MAKE A DIFFERENCE! The Minnesota Department of Human Services impacts the lives of 1.7 million people every year, helping them meet their basic needs so they can achieve their highest potential.

Working together to improve the state we love.

What do Minnesota's State employees have in common?

• A sense of purpose in their work
• Connection with their coworkers and communities
• Opportunities for personal and professional growth
  
  

Benefits

As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well.

Your benefits may include:

• Paid vacation and sick leave
• 12 paid holidays each year
• Low-cost medical, dental, vision, and prescription drug plans
• Fertility care, including IVF
• Diabetes care
• Dental and orthodontic care for adults and children
• 6 weeks paid leave for parents of newborn or newly adopted children
• Pension plan that provides income when you retire (after working at least three years)
• Employer paid life insurance to provide support for your family in the event of death
• Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
• Tax-free expense accounts for health, dental, and dependent care
• Resources that provide support and promote physical, emotional, social, and financial well-being
  
  

Support to help you reach your career goals:

• Training, classes, and professional development
• Tuition reimbursement
• Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov)
  
  

Employee Assistance Program (EAP) for work/life support:

• A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance
• Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues
• Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care
  
  

Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.

EQUAL OPPORTUNITY EMPLOYERS

Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S community, individuals with disabilities, women, and veterans to apply. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law.

Applicants With Disabilities

Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email careers@state.mn.us and let us know the support you need.