Benefits Program Worker II - Fraud Investigator

GENERAL DESCRIPTION OF CLASS
The purpose of the position is to assist and support Chesapeake citizens in obtaining services provided by public and private agencies, and/or perform quality control for area of responsibility. The position is responsible for quality control and/or client assessment, investigating fraud, calculating overpayments, initiating Administrative or Court Action on all Intentional Program Violations, establishing overpayment and overseeing collections referrals, eligibility determination for financial and medical assistance, service delivery, and reporting. The position works within a general outline of work to be performed; develops work methods and sequences under general supervision.

ESSENTIAL TASKS
The tasks listed below are those that represent the majority of the time spent working in this position. Management may assign additional tasks related to the type of work of the position as necessary.

• Receives, evaluates and tracks allegations of suspected fraud;
• Conducts an inquiry and investigation into the allegation in an effort to determine intent or no intent on the part of the client in all program areas;
• Calculates overpayments when the overpayment is discovered through a fraud investigation.
• prepare reports; apply principles of persuasion and/or influence; document data from interviews, forms, and documents; and organize own work schedule
• Reviews all new policy and procedures; and stays a breast of federal, state, and local guidelines and regulations for area of responsibility.
• Maintains Fraud Free database tracking system.
• Interviews customer and conducts assessment of eligibility for services; explains available programs and services; assists with completion of application process.
• Dictates narrative of case; completes computer forms to establish case on various computer systems; analyzes available information and determines and recommends client eligibility.
• Examines public assistance records/cases for completeness and accuracy; reviews accounts payable to ensure accuracy and timeliness of assistance payments.
• Performs routine office tasks such as typing correspondence, data entry, filing, telephoning, faxing, and photocopying; maintains record system for area of responsibility.
• Attends staff, team, committee, and other professional meetings to exchange information; meets with general public and community organizations to discuss programs for area of responsibility.

TYPICAL TASK:

• Receives referrals of suspected fraud form program workers and other sources including community complaints (anonymous or not) and computer matches.
• Analyzes allegations(s) and identifies the program regulations(s) which has been violated.
• Demonstrated ability to: communicate effectively both orally and in writing; perform addition, subtraction, multiplication, and division; calculate overpayments and track payments;
• Gathers and analyzes evidence to substantiate that fraud has or has not occurred. Testify in court proceedings; establish and maintain effective working relationships with clients, associates, law enforcement, other agencies and others;
• Conducts witness and suspect interviews and takes statements as appropriate.
• Work independently; analyze data, recognize gaps and collect information; draw legal and supportable conclusions;
• Establishes intent, if it exists. Determines suitability of cases for the Administrative Disqualification Hearing (ADH) processor for prosecution based on guidelines provided by the local Commonwealth's Attorney.
• Prepares comprehensive investigative reports. Testifies in court or presents evidence at ADH's. Maintains appropriate record and files. Compiles statistical information and creates reports as required.

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