Benefit Integrity Analyst

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Job Description

The Texas Health and Human Services Commission (HHSC) seek highly qualified candidates to fill the Texas Works Advisor IV position within the Office of Medical and Social Services (MSS), Access and Eligibility Services (AES) Integrity Support Services (ISS). The MSS is driven by its mission to connect people, services, and supports by helping individuals and families in need of food, medical care, cash assistance and other social services. The ideal candidate will thrive in an environment that emphasizes: innovation through new ideas, striving for excellence by taking pride in your work, embracing our differences as a source of strength, accomplishing more through partnership, leading by example, and learning for continuous improvement. Texas Works Advisor IV. The Texas Health and Human Services (HHS) seek highly qualified candidates to fill the Advisor IV within the Access & Eligibility Services (AES) Department Eligibility Operations Integrity Support Services (ISS). AES is driven by the mission to connect Texans to services by helping individuals and families in need of food, medical care, cash assistance, and other social services. Functions as an analyst that performs (senior-level) eligibility determination reviews for social service programs. Reviews and analyzes cases to prevent potential fraud prior to certification. Under the direction of management, reviews cases for compliance of public assistance laws and regulations. Applies regulations and procedures to determine accurate eligibility for public assistance programs. The TWA IV evaluates, summarizes, documents findings, and prepares detailed case reports. Collects information and prepares records for referral to analysts to conduct hearings and appeals and responds to client complaints. Reviews suspected fraud cases; identifies and contacts potential witnesses and clients. Makes collateral calls to verify recipient case information. Reviews and analyzes documents and reports from multiple agency, state, and federal databases to collect data and to determine, or verify, new and continued program eligibility. Assists with development and delivery of training presentations to HHS staff. Work involves coordinating the review of eligibility cases, verifying information with clients, collateral sources, residential facilities and employers. Verifies case data and resolves problems and complaints. Works under limited supervision, with considerable latitude for the use of initiative and independent judgment. Monitor, reviews, and communicates case status and changes to clients and/ or authorized representatives. Communicates all case changes and provides status updates to the management team and/or Director of the Eligibility Operations-Integrity Support Services (ISS).

Essential Job Functions:

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Reviews suspected fraud cases and makes referrals to Office of Inspector General investigators as needed. Reviews case records to determine validity and accuracy of eligibility determinations made by other staff. Conducts effective reviews and obtains information by observing and recording examinations. Performs fact-finding client interviews.

Analyzes and evaluates the client’s statements. Interprets, understands, and applies provisions of public assistance laws. Prepares clear and concise written and oral reports while dealing effectively with the public and departmental staff. Documents case files using automated equipment to form a case record for each client. Initiates, monitors, and manages service improvement projects and reports on activities Performs other duties as assigned. Analyzes situations accurately and adopts an effective course of action to resolve discrepancies.

Responsible for explaining program benefits and requirements to clients and/or advisor staff as necessary. Resolves problems and complaints. Presents findings and provides status updates to the management team and/or Director of the ISS. Assists in the oversight and development of eligibility functions which includes recommendations for development of training, operational policies and procedures. Monitors completion of referred precertification cases by field Advisors. Provides quality improvement opportunities to the Eligibility Operations-Field Operations (EO-Field Ops) to ensure eligibility determination and benefit issuance are timely and accurate according to state and federal regulations. Assists in the oversight, review and evaluation of information regionally as it relates to service delivery systems. Evaluates output activities and findings in order to identify gaps in resources, improvements or trends that impact business flow, agency goals, objectives, and the overall strategic plan for the program area. Provides consultative services and technical assistance to plan, implement and monitor effective programs and services. Provides information and may serve as a liaison with local, state, and federal agencies for the prevention and suppression of fraudulent benefit activities. Compiles data, conducts analysis, prepares correspondence, and reports on the validity and accuracy of eligibility determinations. Attends meetings, trainings, and workshops related to program benefits, requirements, rights to appeal and fair hearings to clients. Compiles information to be used in bulletins, articles, and publications for the benefit of eligibility determination staff and/or clients and their authorized representatives. Assists in the oversight of the preparation and development of legislative initiatives, analysis, and other complex documents that support the agency and the determination of eligibility for EO services and programs. Prepares responses for request for information within EO. May initiate and monitor special projects.

Knowledge Skills Abilities:

Knowledge of local, state and federal laws and regulations relevant to program areas. Comprehension of fraud prevention and fraud detection for SNAP, TANF, CHIP and Medicaid Programs. Skill in communicating effectively both orally and in writing. Ability to exercise judgment and work independently with minimal supervision. Ability to work cooperatively in a team environment. Ability to use word processing and spreadsheet applications in a Windows environment. Knowledge of SNAP, TANF, Medicaid and CHIP Programs. Awareness of HHS Enterprise agencies and programs. Knowledge of strategic planning and program evaluations. Skill In developing and evaluating policies and procedures; to assess risk and develop contingency plans: and to make recommendations and decisions. Aptitude in problem solving and independent decision-making. Skill in establishing and maintaining effective working relationships with co- workers, subordinates, and supervisors. Skilled in communicating ideas and instructions dearly and concisely. Skill in project management and the ability to identify problems, evaluate alternatives and implement effective solutions. Ability to serve as agency spokesperson in matters related to program management and operations. Ability to exercise creative problem-solving techniques in a highly complex environment. Ability to analyze and solve problems and make decisions affecting overall operations. Proficiency to set and manage priorities judiciously. Ability to organize and develop work plans, coordinate administrative assignments, and adhere to strict deadlines. Ability to plan, assign and supervise the work of others.

Registration or Licensure Requirements:

N/A

Initial Selection Criteria:

High School diploma or GED equivalent is required. Sixty (60) semester hours from an accredited college or university is required OR relevant customer service experience may be substituted for education. Degree from an accredited college or university is preferred. Two years’ experience determining eligibility for SNAP, Medicaid, and/or TANF. The experience should be within the last two years. Experience conducting fraud analysis related to human services programs preferred. Experience which indicates skill in data review and analysis required. Experience evaluating eligibility cases for accuracy and fraud detection preferred. Training or experience in fact-finding principles preferred. Experience working in a professional customer service environment required. Experience which demonstrates skill in communicating verbally and in writing required. Application indicates willingness to work beyond normal work hours of 8AM-5PM as needed/required. Application indicates the willingness to travel 20% of the time required.

Additional Information:

Note: Current employee applicants should list each position held separately. For example, Texas Works Advisor I job experience must be listed separately from Texas Works Advisor II job experience. ****Open internal and external**** Number of positions to be filled: 4. The location of the positions will be determined after selection of the candidates.

Applicants may not have a history of substantiated fraudulent activity against HHSC or any programs it administers. Applicants who have a non-fraud overpayment with an outstanding balance must agree to repay the overpayment balance as a condition of employment. Note: There may be no military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position. All active duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx.

HHS agencies use E-Verify.

You must bring your I-9 documentation with you on your first day of work. I-9 Form -

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form