Columbus - BWC Fraud Investigator - PN - 20066780
About the position
With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.
BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.
To transform BWC into an agile organization driven by customer success.
To deliver consistently excellent experiences for each BWC customer every day.
One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website !
This position is considered a field position and will not be required to report into a physical office on daily basis but based on operational need or as determined by division chief. Employee will be required to report to an office for at minimum 6 months of training during initial probation or as deemed by division chief.
Responsibilities
• Interview subjects of health care fraud investigations to obtain statements, affidavits &/or confessions
• Interviews & documents contact with other individuals (e.g., informants, witnesses, physicians, attorneys, victims) associated with allegations of health care fraud.
• Collects & preserves all evidence to support case findings.
• Prepare concise, accurate & detailed investigative reports.
• Operate a personal computer (e.g., develops & maintains databases, creates & maintains spreadsheets, enter all investigative activities, searches the internet to locate resources) daily.
• Conduct covert surveillance and undercover activities to identify fraudulent activity perpetrated by health care providers.
Requirements
• Completion of associate core program in criminology, criminal justice, or law enforcement; 18 mos. exp. in conducting criminal investigations. (Note: conducting criminal investigations is defined as performing field interviews & interrogation, field surveillance, field information & evidence gathering techniques while conducting investigations involving violations of criminal law (i.e., special emphasis on theft & fraud cases) as well as researching various administrative laws, policies & procedures related to commission of possible criminal offenses); if required to operate state vehicle valid driver’s license.
• Or, for positions focused on forensic accounting/auditing: Completion of associate core program in forensic accounting/auditing or accounting: 18 mos. exp. in performing forensic accounting/auditing duties; if required to operate state vehicle valid driver’s license.
• The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment.
• Or equivalent of Minimum Class Qualifications For Employment noted above.
• Pursuant to Ohio Administrative Code Chapter 4501users of system shall adhere to policies & guidelines published in NCIC operating manual, CJIS security policy, LEADS operating manual, LEADS security policy, newsletters, & administrative messages from LEADS, all of which are either available on ODPS/LEADS intranet or disseminated to LEADS agencies; pursuant to LEADS security policy (revised 05/07/03) state & national fingerprint-based record checks must be conducted within 30 days of initial employment or assignment of all personnel, including appropriate IT personnel, having access to LEADS, or to records storage areas containing CCH/II data; minimum check must include submission of both a State of Ohio BCI& I card & an FBI applicant fingerprint card; both completed applicant fingerprint cards must be submitted by employing agency to State of Ohio Bureau of Criminal Identification & Investigation for processing & forwarding to Federal Bureau of Investigation; record of this check must be kept by employing agency & made available to LEADS upon request; fingerprint card returned by Ohio BCI&I is sufficient documentation. Pursuant to Ohio Administrative Code Chapter 4501 terminal agency shall conduct a complete background investigation of all terminal operators including, but not limited to: an applicant fingerprint card submission to BCI&I & FBI, an inquiry of state & national arrest & fugitive files; terminal agency is required to notify CTO of any applicant’s criminal record; existence of a criminal record may result in denial of access.
• Knowledge of : criminology, criminal justice or law enforcement; BWC, state & &/or federal statutes, rules, regulations & procedures applicable to investigations; evidence gathering & search & seizure; public relations; interviewing; case preparation; LEADS operator rules & regulations; human relations.
• Skill in : operation of personal computer, database & spreadsheet software; analytical software used in fraud detection; surveillance equipment (e.g. cameras, camcorders, mini cameras, undercover audio/video recording devices).
• Ability to: define problems, collect data, establish facts & draw valid conclusions; gather, collate, & classify information about data, people &/or things; prepare meaningful, concise & accurate reports; conduct interviews effectively; assess immediate situation & make split-second decisions; handle sensitive inquiries from & contacts with officials & general public; safely handle irate &/or dangerous citizens; recognize unusual or threatening conditions & take appropriate action; independently deal with many variables & determine specific action during investigative process; comprehend & record figures accurately; add, subtract, multiply & divide whole numbers; calculate fractions, decimals & percentages; understand manuals & verbal instructions, technical in nature; use proper research methods in gathering data; work in isolation.
Benefits
• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) & Optional Deferred Compensation ( Ohio Deferred Compensation )
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With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.
BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.
To transform BWC into an agile organization driven by customer success.
To deliver consistently excellent experiences for each BWC customer every day.
One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website !
This position is considered a field position and will not be required to report into a physical office on daily basis but based on operational need or as determined by division chief. Employee will be required to report to an office for at minimum 6 months of training during initial probation or as deemed by division chief.
Responsibilities
• Interview subjects of health care fraud investigations to obtain statements, affidavits &/or confessions
• Interviews & documents contact with other individuals (e.g., informants, witnesses, physicians, attorneys, victims) associated with allegations of health care fraud.
• Collects & preserves all evidence to support case findings.
• Prepare concise, accurate & detailed investigative reports.
• Operate a personal computer (e.g., develops & maintains databases, creates & maintains spreadsheets, enter all investigative activities, searches the internet to locate resources) daily.
• Conduct covert surveillance and undercover activities to identify fraudulent activity perpetrated by health care providers.
Requirements
• Completion of associate core program in criminology, criminal justice, or law enforcement; 18 mos. exp. in conducting criminal investigations. (Note: conducting criminal investigations is defined as performing field interviews & interrogation, field surveillance, field information & evidence gathering techniques while conducting investigations involving violations of criminal law (i.e., special emphasis on theft & fraud cases) as well as researching various administrative laws, policies & procedures related to commission of possible criminal offenses); if required to operate state vehicle valid driver’s license.
• Or, for positions focused on forensic accounting/auditing: Completion of associate core program in forensic accounting/auditing or accounting: 18 mos. exp. in performing forensic accounting/auditing duties; if required to operate state vehicle valid driver’s license.
• The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment.
• Or equivalent of Minimum Class Qualifications For Employment noted above.
• Pursuant to Ohio Administrative Code Chapter 4501users of system shall adhere to policies & guidelines published in NCIC operating manual, CJIS security policy, LEADS operating manual, LEADS security policy, newsletters, & administrative messages from LEADS, all of which are either available on ODPS/LEADS intranet or disseminated to LEADS agencies; pursuant to LEADS security policy (revised 05/07/03) state & national fingerprint-based record checks must be conducted within 30 days of initial employment or assignment of all personnel, including appropriate IT personnel, having access to LEADS, or to records storage areas containing CCH/II data; minimum check must include submission of both a State of Ohio BCI& I card & an FBI applicant fingerprint card; both completed applicant fingerprint cards must be submitted by employing agency to State of Ohio Bureau of Criminal Identification & Investigation for processing & forwarding to Federal Bureau of Investigation; record of this check must be kept by employing agency & made available to LEADS upon request; fingerprint card returned by Ohio BCI&I is sufficient documentation. Pursuant to Ohio Administrative Code Chapter 4501 terminal agency shall conduct a complete background investigation of all terminal operators including, but not limited to: an applicant fingerprint card submission to BCI&I & FBI, an inquiry of state & national arrest & fugitive files; terminal agency is required to notify CTO of any applicant’s criminal record; existence of a criminal record may result in denial of access.
• Knowledge of : criminology, criminal justice or law enforcement; BWC, state & &/or federal statutes, rules, regulations & procedures applicable to investigations; evidence gathering & search & seizure; public relations; interviewing; case preparation; LEADS operator rules & regulations; human relations.
• Skill in : operation of personal computer, database & spreadsheet software; analytical software used in fraud detection; surveillance equipment (e.g. cameras, camcorders, mini cameras, undercover audio/video recording devices).
• Ability to: define problems, collect data, establish facts & draw valid conclusions; gather, collate, & classify information about data, people &/or things; prepare meaningful, concise & accurate reports; conduct interviews effectively; assess immediate situation & make split-second decisions; handle sensitive inquiries from & contacts with officials & general public; safely handle irate &/or dangerous citizens; recognize unusual or threatening conditions & take appropriate action; independently deal with many variables & determine specific action during investigative process; comprehend & record figures accurately; add, subtract, multiply & divide whole numbers; calculate fractions, decimals & percentages; understand manuals & verbal instructions, technical in nature; use proper research methods in gathering data; work in isolation.
Benefits
• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) & Optional Deferred Compensation ( Ohio Deferred Compensation )
Apply tot his job
Apply To this Job