OIG SPECIAL INVESTIGATOR 1* - 01072025-64291
 State of Tennessee | |||||||||||||||
 United States, Tennessee, Nashville | |||||||||||||||
 Jan 07, 2025 | |||||||||||||||
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Job Information State of Tennessee Job Information
LOCATION OF (1) POSITION(S) TO BE FILLED: DEPARTMENT OF FINANCE AND ADMINISTRATION, OFFICE OF INSPECTOR GENERAL DIVISION, DAVIDSON COUNTY Qualifications Education and Experience: Graduation from an accredited college or university with a Bachelor's Degree and experience equivalent to two years in public or private health care systems, state or federal benefit programs, medical coding, or claims billing.
OR Graduation from an accredited college or university with an Associate's Degree and experience equivalent to four years in public or private health care systems, state or federal benefit programs, medical coding, or claims billing. Substitution of Experience for Education: Qualifying full-time experience in public or private health care systems, state or federal benefit programs, medical coding, or claims billing may be substituted for the required education on a year-for-year basis to a maximum of four years. OR Two years of professional governmental social services work. Necessary Special Qualifications:
Applicants for this class must: 1. Have a good moral character, as determined by investigation; 2. Complete a criminal history disclosure form in a manner approved by the appointing authority; 3. Agree to release all records involving their criminal history to the appointing authority; 4.Supply a fingerprint sample in a manner prescribed by the TBI for a finger print based criminal history records check. Examination Method: Education and Experience,100%, for Preferred Service positions. Overview SUMMARY:
Under general supervision, is responsible for performing TennCare fraud investigative work of moderate difficulty and volume; and performs related work as required. DISTINGUISHING FEATURES: This is the first working-level class in the OIG Special Investigator? sub-series. An employee in this class performs investigation and maintenance of a moderate caseload of Medicaid eligibility fraud complaints and refer cases to the Criminal Investigations Division and Civil/Administrative Division, following Eligibility Integrity Unit Standard Operating Procedures. This class differs from that of OIG Review Specialist 2 in that an incumbent of the latter compiles information into referrals for the purposes of building a case. This class differs from that of OIG Special Investigator 2 in that an incumbent of the latter performs case analysis at a significantly higher volume. *An applicant appointed to this flexibly staffed class will be reclassified to OIG Special Investigator 2 after successful completion of a mandatory one-year training period. Inadequate or marginal performance during the training period will result in termination. Responsibilities 1. Analyze, interpret, and process information from Case Management systems, various databases, and supporting documents to prepare a Preliminary Case Review Summary to verify accuracy of information. Competencies (KSA's) Competencies: Tools & Equipment 1. Computer | |||||||||||||||