California Department of Justice
Job Description
Interested in fighting healthcare fraud using analytical and quantitative skills? This role provides an opportunity to recover stolen funds, protect the Medi-Cal Program against false claims, and assist in safeguarding vulnerable populations. The Division of Medi-Cal Fraud and Elder Abuse seeks auditors with strong data management and investigative capabilities and a commitment to detecting and combating fraud. Responsibilities
Conduct complex civil audits and investigations for the Civil Section. Collaborate with auditors and attorneys from other state Medicaid Fraud Control Units and/or Federal Assistant United States Attorneys to combat health fraud. Review and provide claims data of suspected activity and assist in civil remediation. Obtain and analyze information from Medi-Cal claims databases and other evidence from multiple sources related to cases of alleged Medi-Cal provider fraud. Identify, gather, and maintain voluminous data relevant to such allegations. Estimate and calculate monetary losses to the Medi-Cal program, assess reasonableness of audit findings, and evaluate results through comparative analysis and independent verification. Conduct interviews and fieldwork as needed, compile and evaluate evidentiary material, develop audit findings, and prepare detailed investigation reports and schedules of findings. Participate in meetings, depositions, and interviews with relators, investigative and legal staff, and private firms and agencies. Develop forensic investigative strategies and identify resources to perform audit and investigative assignments. Collaborate with teams of attorneys, paralegals, support staff, investigators, agents, auditors, and other analysts. Utilize computerized audit tools (e.g., MIS/DSS claims database, Business Objects, Medi-Cal MIS, Lexis-Nexis, Microsoft Office, SAS Enterprise Guide) to develop programs for sampling, cost evaluations, pattern detection, and trend analysis. Assist in the preparation and service of subpoenas, and in the preparation of discovery requests and responses. Assist in matters set for hearing, settlement, and trial, including testifying in civil hearings, depositions, and trials (in person or by affidavit). Position Details
Job Code: JC-491282 Position #(s): 423-655-4175-003 Working Title: Auditor I Classification: AUDITOR I Salary: $4,256.00 - $5,600.00 New to State candidates will be hired at the minimum salary of the classification or the minimum of the alternate range when applicable. Shall Consider: INVESTIGATIVE AUDITOR III, II, IV (Specialist) qualifications with respective salary ranges listed in the notice. Number of Positions: 1 Work Location: Sacramento County Telework: Hybrid Job Type: Permanent, Full Time Facility: DMFEA Personnel Work Shift: Day Work Week: Monday - Friday Department Information: This position is located in the Division of Medi-Cal Fraud and Elder Abuse, Investigations Section, San Diego Regional Office or Sacramento Regional Office. There is a total of 1 position. This position may be filled in either San Diego (JC-485319) or Sacramento (JC-491282). Applications are welcome for both locations and only one STD 678 State Application is needed. Please indicate your preferred city or cities and the corresponding JC code(s) in the State Application. Other notes: All new state employees will be paid at the minimum salary for the classification. For current state employees, salary will be determined according to applicable laws and regulations. Benefits
Work-life balance 11 paid holidays Flexible paid leave options Consistent wage increases Pension retirement Job stability Health/Dental/Vision Insurance Public Service Loan Forgiveness (PSLF) and more Seniority level
Associate Employment type
Full-time Job function
Accounting/Auditing and Finance Industries: Law Enforcement Referrals increase your chances of interviewing at the California Department of Justice.
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Interested in fighting healthcare fraud using analytical and quantitative skills? This role provides an opportunity to recover stolen funds, protect the Medi-Cal Program against false claims, and assist in safeguarding vulnerable populations. The Division of Medi-Cal Fraud and Elder Abuse seeks auditors with strong data management and investigative capabilities and a commitment to detecting and combating fraud. Responsibilities
Conduct complex civil audits and investigations for the Civil Section. Collaborate with auditors and attorneys from other state Medicaid Fraud Control Units and/or Federal Assistant United States Attorneys to combat health fraud. Review and provide claims data of suspected activity and assist in civil remediation. Obtain and analyze information from Medi-Cal claims databases and other evidence from multiple sources related to cases of alleged Medi-Cal provider fraud. Identify, gather, and maintain voluminous data relevant to such allegations. Estimate and calculate monetary losses to the Medi-Cal program, assess reasonableness of audit findings, and evaluate results through comparative analysis and independent verification. Conduct interviews and fieldwork as needed, compile and evaluate evidentiary material, develop audit findings, and prepare detailed investigation reports and schedules of findings. Participate in meetings, depositions, and interviews with relators, investigative and legal staff, and private firms and agencies. Develop forensic investigative strategies and identify resources to perform audit and investigative assignments. Collaborate with teams of attorneys, paralegals, support staff, investigators, agents, auditors, and other analysts. Utilize computerized audit tools (e.g., MIS/DSS claims database, Business Objects, Medi-Cal MIS, Lexis-Nexis, Microsoft Office, SAS Enterprise Guide) to develop programs for sampling, cost evaluations, pattern detection, and trend analysis. Assist in the preparation and service of subpoenas, and in the preparation of discovery requests and responses. Assist in matters set for hearing, settlement, and trial, including testifying in civil hearings, depositions, and trials (in person or by affidavit). Position Details
Job Code: JC-491282 Position #(s): 423-655-4175-003 Working Title: Auditor I Classification: AUDITOR I Salary: $4,256.00 - $5,600.00 New to State candidates will be hired at the minimum salary of the classification or the minimum of the alternate range when applicable. Shall Consider: INVESTIGATIVE AUDITOR III, II, IV (Specialist) qualifications with respective salary ranges listed in the notice. Number of Positions: 1 Work Location: Sacramento County Telework: Hybrid Job Type: Permanent, Full Time Facility: DMFEA Personnel Work Shift: Day Work Week: Monday - Friday Department Information: This position is located in the Division of Medi-Cal Fraud and Elder Abuse, Investigations Section, San Diego Regional Office or Sacramento Regional Office. There is a total of 1 position. This position may be filled in either San Diego (JC-485319) or Sacramento (JC-491282). Applications are welcome for both locations and only one STD 678 State Application is needed. Please indicate your preferred city or cities and the corresponding JC code(s) in the State Application. Other notes: All new state employees will be paid at the minimum salary for the classification. For current state employees, salary will be determined according to applicable laws and regulations. Benefits
Work-life balance 11 paid holidays Flexible paid leave options Consistent wage increases Pension retirement Job stability Health/Dental/Vision Insurance Public Service Loan Forgiveness (PSLF) and more Seniority level
Associate Employment type
Full-time Job function
Accounting/Auditing and Finance Industries: Law Enforcement Referrals increase your chances of interviewing at the California Department of Justice.
#J-18808-Ljbffr