Special investigator job description

Love the thrill of investigative work? Enjoy being around horses and the horseracing environment? If so, this is certainly the position for you! As a Special Investigator 1 with the Department of Agriculture, you'll collect and assemble pertinent facts of information towards any of various types of internal and external investigations. The scope of the investigations cover inquiries into possible violations of the rules of racing, activities of persons past and present, criminal and civil, who now hold or are applying for a Commission license. Join our team today!

As a Special Investigator 1, you will enforce the rules and regulations of the Pennsylvania Harness Racing Commission so that the integrity of racing is upheld.

Interested in learning more? Additional details regarding this position can be found in the position description.
Work Schedule and Additional Information:

* Full-time employment.
* Work schedule is vendor controlled and is determined by the racing schedule.

Shifts alternate: Early shift 7:30 am - 3:30 pm and Late shift 10:00 am - 6:00 pm.
* Must be available to occasionally participate in out of Comp testing, Fairs and Special Events.
* A Commission employee license will be given for this position after time of hire.
* Salary: In some cases, the starting salary may be non-negotiable.
* You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

QUALIFICATIONS

Minimum Experience and Training Requirements:

* Two years of experience in criminal investigation work and a bachelor's degree; Or
* Any equivalent combination of experience and training.

Additional Requirement:

* You must be able to perform essential job functions.

How to Apply:

* Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
* If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
* Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted
* Failure to comply with the above application requirements may eliminate you from consideration for this position.

Telecommunications Relay Service (TRS):

* 711 (hearing and speech disabilities or other individuals).

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.

Primary Job Function: Compliance

ID**: 22833

Your career starts now. We're looking for the next generation of health care leaders.

At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

**Responsibilities:**

The Investigator is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products at the AmeriHealth Caritas Family of Companies (ACFC).

Major Accountabilities:

+ Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations.

+ Performance of data-mining activities to identify potential cases for investigation.

+ Performing sampling methodologies for medical record requests/reviews (e.g., OIG SVRS tool, Probe or random sampling).

+ Conducts investigations of potential fraud, waste and/or abuse with a focus on thoroughness and attention to detail, quality, timeliness and cost control.

+ Conducts comprehensive interviews with providers, members and witnesses to obtain information which would be considered admissible under generally accepted criminal and civil rules of evidence.

+ Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrant claims billing and practice patterns.

+ Analyzes data as part of the investigative process using available fraud detection software and corporate resources.

+ Represents ACFC in conducting settlement negotiations with providers, counsel and/or other associated parties.

+ Prepares and submits investigative reports covering all phases of the investigation.

+ Interprets and conveys highly technical information to others.

+ Establishes and maintains liaison with public officials, law enforcement and others to obtain assistance in conducting investigations.

**Education/ Experience:**

+ Bachelor's Degree preferred.

+ Valid driver's license required.

+ Ability to work independently with minimal supervision, and manage a high volume of assignments.

+ Strong verbal and written communication skills.

+ High degree of integrity and confidentiality required handling information that is considered personal and confidential.

+ Analytical skills and ability to make deductions; logical and sequential thinker.

+ A minimum of 3-5 years experience conducting comprehensive health care fraud investigations; interacting with state, federal and local law enforcement agencies.

**Other Skills:**

+ Health care industry and/or Medicare/Medicaid/Pharmacy/Behavioral Health/Pharmacy Benefit Management knowledge required.

+ SIU and/or State Medicaid regulatory compliance work experience preferred.

+ Knowledge and proficiency in claims adjudication standards & procedures preferred.

+ Solid knowledge of Medicaid, Medicare, and pharmacy benefit laws and requirements; federal, state, civil and criminal statutes.

+ Experience with decision support tools used for data analysis.

+ Advanced knowledge and experience working on various approaches to fraud, waste and abuse.

+ Working knowledge of Microsoft applications, especially Excel required.

+ Knowledge of available resources (internal and external) to assist in investigations.

EOE Minorities/Females/Protected Veterans/Disabled

Primary Location: United States of America-OHIO-Franklin County-ColumbusWork Locations: Health Department Building 246 North High Street 1st Floor Columbus 43215Organization: HealthClassified Indicator: UnclassifiedBargaining Unit / Exempt: Bargaining UnitSchedule: Full-time Work Hours: 8AM-5PMCompensation: $27.03/hr Unposting Date: OngoingJob Function: Public HealthJob Level: Individual Contributor Agency Contact Name: Regan MyersAgency Contact Information: You will be contacted via phone/email if selected for interview. SPECIAL PROJECT (LONG-TERM TEMPORARY): Epidemiology Investigator 2 - HAIs/Antimicrobial Resistance (PN 20013641) (2200067A) Job Duties
About Us:
Our mission at the Ohio Department of Health (ODH) is advancing the health and well-being of all Ohioans. Our agency is committed to building a modern, vibrant public health system that creates the conditions where all Ohioans flourish.
The Ohio Department of Health supports a hybrid teleworking model. This position may work a hybrid schedule at the discretion of the manager or supervisor, which will require occasional attendance in the office for training, meetings and other operational needs. Employees must reside within a reasonable distance to their assigned headquarters for compliance with workplace reporting requirements.

What You'll Do:
The Healthcare-Associated Infections/Antimicrobial Resistance (HAI/AR) Program targets HAis, antimicrobial resistant organisms, and emerging infectious diseases like COVID-19, CP-CRE, and Candida auris. As Epidemiology Investigator 2, you'll conduct surveillance, educate healthcare professionals and the public, provide outbreak support to local health districts, and cross-train to provide coverage for other investigations, as needed. Currently, we expect this project to run through July 2024.
Key responsibilities, at a glance:

Investigate COVID-19, antimicrobial resistance (AR), and other HAI outbreaks through onsite visits, data collection, studies, and computerized statistical analysis:

support local health departments' mitigation activities
collect and/or monitor collection of disease surveillance data
evaluate data against CDC case definition, tabulate, and analyze via statistical software (e.g., SAS)
interpret findings and reach conclusions regarding unusual occurrences, causes, spread, and prevention
monitor specimen collection, delivery to laboratory, and reporting of results
conduct analysis (e.g., epidemiologic, biostatistical, geographic) and create/write/distribute/post reports (scheduled or ad hoc)

Assists with database projects (e.g., planning, testing)
Prepare graphic presentations
Collaborate with local public health agencies and private health care providers to improve reporting COVID-19, AR organisms, and HAIs.
Explain surveillance procedures, epidemiologic methods and analysis findings to professional and lay audiences
UNUSUAL WORKING CONDITIONS: May require travel; may be away from home & normal work site up to 30 days during emergencies; may be exposed to contagious & communicable diseases & toxic or hazardous chemicals.
This is a temporary, special project position and is unclassified in accordance with ORC 124.11(A)(29).

What's in it for you:
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
Medical Coverage

Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan (please see SPECIAL PROJECT COMPENSATION, further down, for details).

Ohio Public Employees Retirement System

OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of his/her salary towards his/her retirement. The employer contributes an amount equal to 14% of the employee's salary. Visit the OPERS website for more information.

Deferred Compensation

The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.

Qualifications MINIMUM CLASS QUALIFICATIONS FOR EMPLOYMENT:

Completion of graduate core program in public health or preventive medicine; AND
3 courses or 9 months' experience in the use of statistical computer software packages; AND
1 course or 3 mos. exp. in epidemiology; AND
1 course or 3 mos. exp. in physiology; AND
1 course or 3 mos. exp. in statistics; AND
1 course or 3 mos. exp. in human relations; AND
1 course or 3 mos. exp. in interviewing; AND
6 mos. exp. working in research or specific laboratory identifying or researching infectious or chronic diseases &/or related environmental health problems; AND
Must be able to provide own transportation

OR

6 months' experience as an Epidemiology Investigator 1 (65761) with the State of Ohio; AND
Must be able to provide own transportation

OR

Equivalent of Minimum Class Qualifications For Employment noted above.

ADDITIONAL QUALIFICATIONS
Applications of those who meet the minimum qualifications will be further evaluated against the following criteria:

Graduate or advanced degree in public health or preventive medicine
Experience in data management
Experience in database computer software packages, e.g., Access, Excel, or FoxPro
Experience in statistical software, e.g., SAS, STATA, or SPSS
Courses in epidemiology - undergraduate 2 pts. each, graduate 3 pts. each.
Training in or experience working with programs related to infectious diseases
Experience in disease surveillance or reporting

All eligible applications shall be reviewed considering the following criteria: qualifications, experience, education and active disciplinary record.

ALL ANSWERS TO THE SUPPLEMENTAL QUESTIONS MUST BE SUPPORTED BY THE WORK EXPERIENCE/EDUCATION PROVIDED ON YOUR CIVIL SERVICE APPLICATION.

SPECIAL PROJECT COMPENSATION:

The selected candidate will be paid in accordance with the AFSCME/OCSEA union contract.
Unless required by contract, the selected candidate will be paid at Pay Grade 32, Step 1 of the AFSCME/OCSEA Pay Range Schedule ($27.03 per hour).
Under the Affordable Care Act (ACA), special project employees may be eligible for healthcare coverage. However, special project employees are not eligible for vision, dental, disability, or life insurance, nor are they eligible for leave accrual of vacation, sick, holiday, personal, or any other paid leave.

APPLICATION PROCEDURES:
All applicants must submit a completed Ohio Civil Service Application using the TALEO System. Paper applications will not be considered. Applicants must clearly indicate how they meet the minimum qualifications and/or position specific minimum qualifications. Applicants are also encouraged to document any experience, education and/or training related to the job duties above. An assessment of these criteria may be conducted to determine the applicants who are interviewed.

STATUS OF POSTED POSITION:
You can check the status of your application online by signing into your profile. Jobs you applied for will be listed. The application status is shown to the right of the position title and application submission details.

EDUCATIONAL TRANSCRIPT REQUIREMENTS:
Official educational transcripts are required for all post-high school educational accomplishments, coursework or degrees claimed on the application. Applicants will be required to submit an official transcript prior to receiving a formal offer of employment. Failure to provide transcripts within five (5) working days of being requested will cause the applicant to be eliminated from further consideration.

Please note that a transcript is considered "official" only if it is an original copy from the educational institution and includes an institutional watermark, ink stamp or embossed stamp. Transcripts printed from the institution's website will not be accepted. ODH reserves the right to assess the academic credibility of an educational entity's award of a putative degree. Background Check Information The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.