Job Description
Job Title:
Program Specialist II (Investigator II) Location:
Oklahoma City, OK Schedule:
Monday - Friday, 8:00 am - 5:00 pm Pay:
$25.00 per hour Job Overview:
Join a dedicated team committed to safeguarding the integrity of Medicaid programs as a Program Specialist II (Investigator II). In this vital role, you will conduct comprehensive investigations into potential policy violations, fraud, and discrepancies within the Medicaid system. Your work directly supports the agency's mission to ensure access to quality health care for all Oklahomans by promoting transparency, accountability, and compliance with state and federal regulations. This position offers an opportunity to make a meaningful impact through detailed analysis, stakeholder collaboration, and investigative reporting. Qualifications:
Bachelor's degree required, with at least two years of professional experience in investigation, auditing, social work, juvenile justice, personnel administration, law enforcement, or child support enforcement working with persons with intellectual disabilities. Certifications such as Certified Fraud Examiner (CFE), Certified Internal Auditor (CIA), Certified Professional Coder (CPC), Certified Medicaid Integrity Program (CMIP), or Law Enforcement/Criminal Justice Certification are preferred. Strong analytical skills and attention to detail. Excellent communication and interpersonal skills. Ability to analyze records, conduct interviews, and collaborate effectively with stakeholders. Physical ability to perform office-based tasks, including extended periods of sitting, computer use, and occasional travel. Responsibilities and Duties:
Accept information referrals and complete screening of allegations to determine investigative needs. Identify case issues and gather evidence based on analysis of charges, complaints, or allegations. Determine the scope, timing, and direction of investigations to ensure thorough case management. Examine records and documents to locate links in chains of evidence or information. Analyze member case information and billing data from medical providers. Review eligibility, medical, and provider documents, and conduct interviews with members, provider staff, and other stakeholders. Obtain and verify evidence through interviews, observations, and record analysis. Collaborate with other offices and agencies to exchange information and coordinate investigative activities. Prepare detailed reports outlining investigation findings and recommendations. Coordinate eligibility updates with relevant OHCA and DHS units. Identify and calculate overpaid claims, documenting findings and making referrals for recovery. Document all case-related information, correspondence, evidence, and findings accurately. Initiate troubleshooting activities, corrective and preventive action plans, and follow-up procedures. Perform other duties as assigned to support program integrity. Why Work for Galt:
Galt is a non-profit staffing agency with the mission to provide, promote, and expand employment opportunities for individuals with disabilities. We give priority in hiring individuals with disabilities including medical, physical, and psychological conditions. Galt has and will continue to create a better workplace - one in which employers have access to skilled and motivated workers, and people of all abilities can find meaningful, sustaining work. A devoted and friendly team that is there to help you every step of the way in advancing your career. Job Application Process:
Galt utilizes online forms and electronic signatures throughout the hiring process. As an employer of people with disabilities, we understand assistance or accommodation may be required. Should you need accommodation, please contact us at 877-361-1277. Note:
Please allow five (5) business days to process your application. IND-1
