What are the responsibilities and job description for the OIG SPECIAL INVESTIGATOR 1* - 01072025-64291 position at State of Tennessee?
Job Information
State of Tennessee Job Information
Opening Date / Time
01 / 07 / 2025 12 : 00AM Central Time
Closing Date / Time
01 / 20 / 2025 11 : 59PM Central Time
Salary (Monthly)
4,517.00 - $6,758.00
Salary (Annually)
54,204.00 - $81,096.00
Job Type
Full-Time
City, State Location
Nashville, TN
Department
Finance & Administration
LOCATION OF (1) POSITION(S) TO BE FILLED : DEPARTMENT OF FINANCE AND ADMINISTRATION, OFFICE OF INSPECTOR GENERAL DIVISION, DAVIDSON COUNTY
Qualifications
Education and Experience : Graduation from an accredited college or university with a Bachelor's Degree and experience equivalent to two years in public or private health care systems, state or federal benefit programs, medical coding, or claims billing.
Graduation from an accredited college or university with an Associate's Degree and experience equivalent to four years in public or private health care systems, state or federal benefit programs, medical coding, or claims billing.
Substitution of Experience for Education : Qualifying full-time experience in public or private health care systems, state or federal benefit programs, medical coding, or claims billing may be substituted for the required education on a year-for-year basis to a maximum of four years.
Two years of professional governmental social services work.
Necessary Special Qualifications :
Applicants for this class must :
- 1. Have a good moral character, as determined by investigation;
- 2. Complete a criminal history disclosure form in a manner approved by the appointing authority;
- 3. Agree to release all records involving their criminal history to the appointing authority;
4.Supply a fingerprint sample in a manner prescribed by the TBI for a finger print based criminal history records check.
Examination Method : Education and Experience,100%, for Preferred Service positions.
Overview
SUMMARY :
Under general supervision, is responsible for performing TennCare fraud investigative work of moderate difficulty and volume; and performs related work as required.
DISTINGUISHING FEATURES :
This is the first working-level class in the OIG Special Investigator? sub-series. An employee in this class performs investigation and maintenance of a moderate caseload of Medicaid eligibility fraud complaints and refer cases to the Criminal Investigations Division and Civil / Administrative Division, following Eligibility Integrity Unit Standard Operating Procedures. This class differs from that of OIG Review Specialist 2 in that an incumbent of the latter compiles information into referrals for the purposes of building a case. This class differs from that of OIG Special Investigator 2 in that an incumbent of the latter performs case analysis at a significantly higher volume.
Responsibilities
1. Analyze, interpret, and process information from Case Management systems, various databases, and supporting documents to prepare a Preliminary Case Review Summary to verify accuracy of information.
2. Review information collected to facilitate the investigation of TennCare fraud, policy violations, and criminal activity.
3. Compile information and justification into a report for referral to criminal investigations division or civil / administrative division for further investigation and review of TennCare fraud, policy violations, and criminal activity.
4. Refer information not related to TennCare fraud to other local, state, and federal agencies for further investigation and review.
5. Maintain a work activity log noting all case progression and updates, actions made during the investigation, and case completion information.
6. Assemble and maintain files per EIU procedures for auditing, and information preservation.
7. Maintain confidentiality when communicating with internal and external agencies to develop cases, and ensure cases are processed correctly.
8. Employee will serve as an emergency backup on the TennCare Fraud Hotline to analyze, compile, interpret, and process information related to TennCare Fraud referrals and enters said information into Case Management system.
9. Maintain knowledge of current TennCare, Medicaid, and Department of Human Services (DHS) rules, regulations, and policies and provide guidance to staff related to these standards.
Competencies (KSA's)
Competencies :
1. Interpersonal Savvy
2. Decision Quality
3. Business Acumen
4. Customer Focus
5. Problem Solving
6. Organizing
7. Planning
8. Priority Setting
9. Integrity and Trust
10. Action Oriented
Knowledge : 1. Clerical
2. Customer and Personal Service
3. Economics and Accounting
4. English Language
5. Law and Government
6. Mathematics
Skills : 1. Writing
2. Complex Problem Solving
3. Judgment and Decision Making
4. Time Management
5. Active Listening
6. Critical Thinking
7. Speaking
8. Reading Comprehension
9. Active Learning
10. Mathematics
Abilities :
1. Inductive Reasoning
2. Deductive Reasoning
3. Oral Expression
4. Oral Comprehension
5. Written Expression
6. Flexibility of Closure
7. Written Comprehension
8. Problem Sensitivity
9. Selective Attention
10. Information Ordering
Tools & Equipment
1. Computer
2. Printer
3. Calculator
4. Fax Machine
5. Copy Machine
6. Scanner
7. Telephone
8. AV Equipment
Salary : $54,204 - $81,096
