Investigations Analyst

The Colorado Medicaid Fraud Control Unit (COMFCU) in the Consumer Protection Section has an opportunity for an Investigations Analyst to partner with the Unit’s investigators and attorneys on criminal and civil investigations. COMFCU is a unique unit with the Department of Law, charged with responsibility to investigate and prosecute fraud in healthcare services, as well as protect Colorado’s vulnerable populations from abuse and neglect. The unit works across the state with local law enforcement and multiple state agencies, as well as across the country with federal law enforcement, federal agencies, and Medicaid Fraud Control Units in other states.

 

This position is open only to Colorado state residents.

The Colorado Medicaid Fraud Control Unit (COMFCU) conducts civil and criminal investigations and prosecutes criminal offenses to include fraudulent activity by Medicaid providers (such as hospitals, doctors, pharmacies, nursing homes, etc.) and patient abuse (such as physical assault, sexual assault, homicide and embezzlement of patient trust funds). The unit receives multiple referrals and evaluates them to determine if they warrant further investigation and criminal prosecution in state or federal courts. Often, the unit acts as the lead investigative agency gathering information from partnering law enforcement and regulatory agencies not limited to numerous local, state and federal agencies within the State of Colorado. This unit provides training and technical assistance to law enforcement agencies within the State of Colorado and, as requested, the COMFCU staff will provide advanced training at state or national levels on certain topics.

WHAT YOU WILL DO

The Investigations Analyst will assist the Medicaid Fraud Control Unit with analytical tasks related to Colorado-specific and multistate criminal and civil investigations. This position works in conjunction with criminal investigators, using data obtained during investigations, along with data from the internet, open source checks, the intelligence community, and other law enforcement and regulatory partners at the local, state, and federal level. Investigations analysts are great puzzle solvers and help create the “big picture” that moves an investigation forward. They work independently to assess complex information and determine trends in criminal activity. They leverage knowledge to prepare briefings, reports, and communications for criminal investigators and prosecutors. Tasks performed by an analyst free up criminal investigators to focus on conducting interviews, preparing affidavits, conducting surveillance, and other field work.

This position will work specifically on complex criminal and civil matters including violations of Colorado’s Medicaid False Claims Act and the federal False Claims Act. Additionally, this position will work on investigative matters involving felony level theft, forgery, cyber-crime, state tax fraud, and other crimes appropriate for investigation and prosecution by the Medicaid Fraud Control Unit.  The Investigations Analyst will:

• Conduct detailed research and analysis of investigative information relating to alleged violations of health care fraud, fraudulent administration of the Medicaid program, and/or the alleged abuse or neglect of patients in health care facilities governed by the State Medicaid program;
• Collect and analyze multiple sources of data obtained during investigations;
• Perform detailed analysis of bank records, reimbursement records, and other financial records to create an accurate picture of a target’s business operations and personal spending;
• Proactively assess complex information, spotting trends, and making real-time analytical judgments;
• Prepare briefings, reports, and communications for criminal investigators and prosecutors;
• Collect and analyze medical data including medical coding data;
• Create documentation to assist with case organization and investigative support including intelligence reports, documentation of the processes used to obtain information, documentation of data analysis, and the review of financial, and other records;
• Organize data in maps, charts, graphs, spreadsheets, databases, PowerPoint presentations, and other images to illustrate correlations and patterns of criminal activity;
• At times, testify before a jury or grand jury regarding analyses, summaries, and conclusions.

Salary note: Although a salary range is listed, salary will be set commensurate with the successful candidate’s qualifications and in compliance with the Equal Pay for Equal Work Act. Salary will be paid on a biweekly basis.

WHAT WE ARE LOOKING FOR

Minimum Qualifications: Please document all relevant experience in detail on your application. Experience will not be inferred or assumed. Any part-time experience listed will be prorated. 

• Six years of professional experience performing data analysis using multiple sources of data. Data analysis experience must include collection, analysis, interpretation, and providing summaries of data.

OR

• A Bachelor’s degree from an accredited institution in computer science, data analytics, criminal justice, forensic science, sociology, psychology, accounting, health care related fields, or a field of study related to the assignment AND two (2) years of professional experience performing data analysis using multiple sources of data. Data analysis experience must include collection, analysis, interpretation, and providing summaries of data.

OR

• A Master’s degree from an accredited institution in business administration, computer science, data analytics, criminal justice, forensic science, health care related fields, or other directly related field of study AND one (1) year of professional experience performing data analysis using multiple sources of data. Data analysis experience must include collection, analysis, interpretation, and providing summaries of data.

Note: Candidates possessing a foreign degree must submit a translation (evaluation) of their degree from an accredited institution, such as The National Association of Credential Evaluations Services in order to be given credit for the degree.

Required Competencies: 

• Strong technical aptitude including proficiency with MS Office applications including Outlook, Word, and Excel and ability to research and learn multiple databases;
• Strong critical thinking and problem solving skills;
• Ability to work with a wide variety of stakeholders on data analysis projects;
• Ability to manage tasks while working on multiple cases at the same time.

Preferred Qualifications: In addition to the minimum qualifications, if you possess any of the following specifically include the details on your application, as this information will be used to assess your qualifications and may be used to determine a top group of applicants.

• Experience using Criminal Justice databases;
• Experience using geospatial systems;
• Experience providing analytical support to a team;
• Experience working with law enforcement criminal investigations units;
• Experience analyzing cell phone and social media data in complex investigations;
• Experience with health care compliance and/or auditing medical billing and coding;
• Experience with financial auditing;
• Outstanding attention to detail;
• Experience presenting findings in visual formats such as maps, charts, graphs, PowerPoint presentations, and other images to illustrate correlations and patterns.

Conditions of Employment: 

• Applicants must pass a thorough background investigation prior to appointment.
• Both in-person and remote work will be required.

Please view the full job announcement for more information, including information about compensation and benefits, and to apply online.