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Fraud Prevention Specialist

WS ALAMO

San Antonio, TX Job Details Full-time $57,614 - $93,138 a year 8 hours ago Qualifications Spreadsheets Bachelor's degree Data-driven problem-solving Productivity software

Full Job Description Position Description:

ORGANIZATION AND PURPOSE

Workforce Solutions Alamo is a nonprofit organization that serves as the leadership and governing body for the region's workforce development system. Workforce Solutions Alamo is responsible for over $100 million dollar budget consisting in local, state, and federal funds. Our mission is Working to Strengthen the Alamo regional economy by growing and connecting talent pipelines to employers. We are guided by the core values of Integrity, Excellence, Innovation, Collaboration, and Accountability. Workforce Solutions Alamo is governed by a 27-member Board of Directors that reflects the diverse constituencies of the regional community: business, economic development, education, labor, community organizations, and government. Our service area includes the counties of Atascosa, Bandera, Bexar, Comal, Frio, Gillespie, Guadalupe, Karnes, Kendall, Kerr, Medina, McMullen, and Wilson.

GENERAL DESCRIPTION

Under the direction of the Director of Quality Assurance, the Fraud Prevention Specialist is responsible for conducting programmatic, and compliance monitoring activities to ensure contractors, subrecipients, and service providers comply with federal, state, Texas Workforce Commission (TWC), and Workforce Solutions Alamo (WSA) requirements. This position supports program integrity through risk assessments, monitoring reviews, fraud detection activities, fiscal testing, appeal hearings, data analysis, and investigative reviews designed to safeguard public funds and ensure eligible families receive appropriate childcare services and provides technical assistance to strengthen compliance, accountability, and continuous improvement across contracted programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Monitoring and Program Integrity Develop, maintain, and enhance monitoring tools, testing methodologies, risk assessment instruments, and risk-based monitoring processes. Develop and implement risk-based monitoring strategies to identify compliance concerns. Conduct monitoring, transaction testing, desk reviews, virtual reviews, and on-site monitoring to ensure compliance with federal, state, local, contractual, and agency requirements. Assess operational, fiscal, compliance, and fraud-related risks and recommend appropriate monitoring strategies. Identify operational, compliance, and fraud risks. Generate risk-based and random monitoring samples using established statistical and analytical methodologies. Perform follow-up reviews to verify implementation and effectiveness of corrective actions. Program Compliance Reviews Conduct detailed reviews and testing of transactions including: Fraud policies and procedures Child care eligibility documentation Attendance verification Child care subsidy authorizations Provider compliance Parent Share of Cost documentation Case file documentation Support service documentation Required participant documentation Reconciliations Evaluate compliance, identify weaknesses, questioned costs, and opportunities to strengthen internal controls while reducing fraud, waste, and abuse. Child Care Program Integrity and Fraud Prevention Conduct comprehensive reviews to detect fraud, waste, abuse, improper payments, misrepresentation, and misuse of public funds. Interview providers, contractors, participants, and staff, as appropriate. Analyze provider billing practices, attendance records, payment transactions, eligibility documentation, case files, and supporting records to identify irregularities and high-risk activities. Review allegations, referrals, exception reports, and high-risk indicators to determine whether further investigation is warranted. Conduct targeted reviews, special investigations, and slant reviews involving suspected fraud or program abuse. Gather, document, and preserve evidence in accordance with agency policies and confidentiality requirements. Identify systemic trends and emerging fraud risks and recommend preventive controls and process improvements. Recommend corrective actions, recovery of funds, administrative remedies, and internal control enhancements to strengthen program integrity. Conduct field visits and on-site investigations as needed Monitoring, Compliance, and Contract Oversight Monitor contractor compliance with child care regulations, contract provisions, subsidy requirements, fiscal standards, and performance expectations. Conduct source documentation reviews, trace work, transaction testing, and validation of reported information. Participate in entrance and exit conferences with contractors and management. Review Personally Identifiable Information (PII) safeguards, confidentiality practices, Equal Opportunity accessibility requirements, and other regulatory compliance areas. Provide technical assistance and monitoring guidance to contractors and Board staff. Validate contractor policies, procedures, and corrective action plans to ensure compliance and continuous improvement. Independence, Ethics, and Investigative Standards Maintain objectivity, independence, confidentiality, and professional judgment while conducting monitoring, compliance, investigative, and review activities. Identify, disclose, and appropriately manage actual, potential, or perceived conflicts of interest. Ensure all findings, conclusions, and recommendations are supported by sufficient documentation, evidence, and applicable records. Conduct monitoring and investigative activities in accordance with established policies, procedures, and due process requirements. Ensure individuals and entities subject to monitoring or investigation receive applicable notice, response, and appeal rights. Maintain impartiality and avoid participation in appeals or review processes involving matters in which the employee conducted or participated in the underlying monitoring, investigation, finding, or determination. Protect the confidentiality and security of sensitive, proprietary, and personal identifiable information obtained during monitoring and investigative activities. Risk Assessment and Continuous Improvement Participate in the development and implementation of annual risk assessments. Analyze operational, financial, compliance, and program performance data to prioritize monitoring activities. Develop recommendations that improve efficiency, accountability, compliance, and program effectiveness. Assist in developing monitoring procedures, fraud detection methodologies, automated monitoring tools, and preventive controls. Support agency-wide quality assurance, continuous improvement, and program integrity initiatives aligned with the Workforce Solutions Alamo Local Plan. Promote ethical conduct, accountability, transparency, and stewardship of public resources. Case Documentation and File Management Maintain complete, accurate, organized, and auditable case files for monitoring reviews, investigations, compliance activities, and program integrity matters. Document investigative methodologies, evidence reviewed, interviews conducted, findings, conclusions, and recommended corrective actions in accordance with established policies and procedures. Ensure all case records are supported by sufficient documentation and evidence and meet organizational, regulatory, legal, and audit requirements. Prepare, review, analyze, and compile case documentation involving suspected fraud, intentional program violations, misrepresentation, overpayments, and other instances of noncompliance by parents, child care providers, contractors, or other program participants. Develop detailed case summaries, reports, and supporting documentation to substantiate findings and support administrative actions, corrective measures, recovery of funds, sanctions, appeals, hearings, and other enforcement actions. Track, document, and monitor corrective action plans, repayment determinations, overpayment recoveries, appeal activities, and the resolution of findings resulting from monitoring or investigative reviews. Prepare and organize case files and supporting materials for management review, internal and external audits, appeals, hearings, investigations, and referrals to appropriate entities. Coordinate with internal departments and external agencies, including investigative, legal, regulatory, and law enforcement entities, to ensure documentation meets applicable requirements for case review, referral, and disposition. Prepare documentation and supporting evidence for matters that may warrant referral for further investigation, administrative action, civil recovery, or criminal prosecution. Ensure all case activities, records, and documentation comply with applicable federal and state laws, Texas Workforce Commission (TWC) requirements, local workforce board policies, and program regulations. Maintain confidentiality, impartiality, due process, and the integrity of case records throughout the monitoring, investigative, review, referral, and appeal processes. Retain and manage case records in accordance with applicable records retention schedules, documentation standards, and audit requirements. Data Analysis, Reporting, and Technology Utilize KinderTrack, KinderConnect, Program Integrity, and other reporting systems to: Perform transaction testing Conduct risk analysis Generate monitoring samples Identify anomalies and exception reports Support fraud detection and investigative activities Prepare clear, accurate, and timely monitoring reports, investigative reports, risk assessments, and compliance summaries. Document findings, questioned costs, recommendations, corrective actions, and program integrity concerns. Maintain monitoring databases, quality assurance systems, technical assistance records, and electronic documentation. Training and Professional Development Maintain current knowledge of: Child Care Services regulations Federal and state grant requirements Monitoring and auditing methodologies Internal control frameworks Fraud detection and prevention techniques Risk assessment methodologies Data analytics and reporting tools Participate in statewide Quality Assurance and Program Integrity workgroups, professional development activities, and knowledge-sharing initiatives. Collaboration and Special Projects Participate as the Appeals Hearing Officer for Child Care Appeals. Conduct Appeal Hearings in accordance with TWC and WSA procedures. Collaborate with Fiscal, Child Care Services, Compliance, Information Technology, Facilities, and other departments to strengthen program operations. Assist management with special projects, investigations, strategic initiatives, and agency-wide program improvement efforts. Coordinate with external agencies, auditors, and oversight entities, as appropriate. Support organizational efforts to ensure accountability, transparency, compliance, and responsible stewardship of public funds. Perform other duties as assigned. Above does not reflect a comprehensive listing of activities, duties or responsibilities that are required of employee. Duties responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

GENERAL/ORGANIZATIONAL COMPETENCIES

Quality/Compliance:

Ensuring compliance with WSA policies, procedures, and regulatory requirements, while maintaining high standards of excellence in program delivery.

Communication:

Clear, effective communication both internally and externally, keeping stakeholders informed and influencing others when necessary.

Initiative:

Proactively taking ownership of tasks and driving projects to completion without requiring direction.

Efficiency:

Managing time and resources effectively to optimize program outcomes

Customer Focus:

Striving to exceed customer expectations and making service processes easier for customers.

Collegiality/Collaboration:

Working cooperatively with internal and external partners to achieve shared goals.

Integrity/Transparency:

Demonstrating ethical behavior, transparency, and trustworthiness in all actions.

Continuous Learning & Self Development:

Embracing opportunities for feedback and growth, staying current with industry best practices. People Management (for those with direct reports): Setting clear expectations, reviewing progress, providing feedback and guidance, holding people accountable.

Problem Solving:

Identifies problems and uses logic, judgment, and data to evaluate alternatives and recommends solutions to achieve the desired organizational goal or outcomes.

Decision Quality:

Makes sound decisions that consider objectives, risks, implications, and agency and governmental regulations.

GENERAL QUALIFICATIONS

To perform this job successfully, the individual must be able to perform each essential job duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. KNOWLEDGE, SKILLS, and

ABILITIES

Strong working knowledge of local, state, and federal laws, rules, regulations, policies, and procedures applicable to Workforce Development programs. To include Child Care & Child Care Quality program areas and of the principles and practices of public administration and management. Ability to gather, assemble, correlate, and analyze facts; to devise solutions to problems; to develop and evaluate policies and procedures; to plan, implement, and coordinate agency programs; to prepare reports; to maintain a thorough understanding of performance measures; to communicate effectively; and to train, schedule, assign, and/or prioritize the work of the staff assigned. Comprehensive knowledge of local, state, and federal laws and regulations related to workforce development and procurement. Expertise in program management, including planning, implementation, and evaluation. Strong leadership and project management skills, with the ability to manage teams and coordinate across departments. Ability to analyze data, prepare reports, and present information clearly to stakeholders. Ability to direct and organize program activities; to establish program goals and objectives that support the strategic plan; to identify problems, evaluate alternatives, and implement effective solutions; to develop and evaluate policies and procedures; to direct the development of program policies and procedures; to prepare concise reports; to make presentations and testify at hearings; and to plan, assign, and/or supervise the work of others Effective skills in program planning, developing, and implementing. Familiar with statistical analysis and policy research. EDUCATION and/or

EXPERIENCE OTHER QUALIFICATIONS

Bachelor's degree from an accredited college or university in Finance, Accounting, Criminal Justice, Cybersecurity, Economics, Business Administration, or Data Analytics or related field required. Master's degree preferred. Minimum of two (2) years of experience leading, conducting or working in fraud related service Minimum of three (3) years of which must have been in administrative management, oversight, or supervisory capacity An equivalent combination of experience, training, and/or education approved by the agency. Certified Fraud Examiner (CFE) credential preferred.

OTHER QUALIFICATIONS

Must be legally eligible to work in the United States. Will require in-region and out-of-region travel; Must have proof of valid driver's license and current auto insurance; must provide own transportation when on company business.

PHYSICAL

DEMANDS and

WORK ENVIRONMENT

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Equal Opportunity Employer Workforce Solutions Alamo is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. The position will close when filled.