Interest Bidders: Please have an updated resume ready to submit to the hiring supervisor/manager when requested. June 1st, 2025, this position has a flexible work arrangement that allows for up to 50% telework with a minimum of 50% working in our office per month. Approximately, 5% travel.

This entry level position 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 • Investigation of activities related 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 referral from provider, recipients, other Department of Human Services (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. Experience must demonstrate the following: • Understanding of the capabilities of automated computer systems and data bases 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/or application of Minnesota statutes and rules • Understanding of health care claims processing operations, claims forms, or editing and coding structures. • A general understanding of the Medicaid program and the services that are provided • A basic understanding 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.