Interest Bidders: Please have an updated resume ready to submit to the hiring supervisor/manager when requested. This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework. Approximately, less than 10% travel. It is the policy of the Department of Human Services that the individual awarded this position successfully complete a Fingerprinting check (MNJIS/CJIS). Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3-business days from the start of employment; and successfully obtain/retain CJIS certification annually.

The Preliminary Investigator will apply knowledge and investigative expertise in order to identify, investigate, and take administrative or legal action in response to suspected fraud, over-utilization and/or abuse of the Minnesota Health Care Programs (MHCP) by enrolled providers. Duties will include but are not limited to the following: • Investigation of activities related to fraud, abuse or over utilization by Minnesota Health Care Program providers. • Review and properly conclude all cases identified through profiling, investigation, assigned by the Manager or Supervisor, through referrals from providers, recipients, other DHS state, local and federal agencies, other third-party payers and the general public. • develop criteria and parameters which will be used to identify provider activity that can be compared to other providers to develop potential cases for investigation.

**To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.** Two (2) years professional experience with investigative techniques and problem resolution skills to manage the investigation and resolution of cases within limitations set by regulations, law and policy; AND Experience must demonstrate the following: • Working knowledge and capabilities of automated computer systems and databases and be able to access, extract, manipulate and present data in different formats to support investigative activities. • Format, analyze, and prepare computer generated reports. • Understanding, interpretation and application of Minnesota statutes and rules • Working knowledge care claims processing operations, claims forms, or editing and coding structures. • Working knowledge of the Medicaid program and the services that are provided • Working knowledge of medical terminology and coding • Presenting factual, investigative reports, referrals, and/or other materials for legal review and consideration in civil or criminal cases.

This position requires a high level of organizational skills, and problem-solving skills which will require knowledge of various MHCP programs, statutes, and rules. • Respond and adapt to changes in priorities, operations practices, policies, procedures, laws, rules and coding systems. • Possess a global understanding of regulations, law and policy relating to health care services and work in-depth with provisions that directly relate to each given case. • An understanding of claims, the processing operations, claims forms, edits and coding structures sufficient to be able to understand the procedures followed and decisions made by claims processing staff. • Apply strong customer service skills while performing the regulatory functions of the job. • Knowledge of the basic principles of civil and criminal law. • Critical thinking skills • Investigative skills • A background in investigations, legal work such as a paralegal, or medical billing and/or coding. • Variety of experiences working effectively with others from different backgrounds and cultures.