GROUP SUPERVISOR (MEDICAID)

APPLICANTS MUST BE PERMANENT IN THE ASSOCIATE FRAUD INVESTIGATOR CIVIL SERVICE TITLE.

The DSS Accountability Office (DSS-AO) is responsible for protecting the integrity of social services programs administered by the New York City Department of Social Services (DSS) and ensuring that DSS complies with all statutory, regulatory, and contractual standards.

The Division of Claims and Collections Division (C&C) is housed within the office of Revenue. They collect cash assistance overpayments from former cash assistance recipients, current salaried New York City employees. It is also responsible for evaluating and assessing the resources of Medicaid Nursing Home residents through computer bank matches. Claims and Collections also assess the income and resources available to the community spouse refusing to support his or her institutionalized spouse and pursue payment when the refusing spouse has excess income or resources.

Claims and Collections verifies income of Medicaid recipients and collects payments from recipients when Medicaid was incorrectly paid. Cases are referred to MICSA for closing. Claims and Collections also monitors personal incidental account balances and collects monies when the balances exceed the allowable levels.

C&C is recruiting for (1) one Associate Fraud Investigator II to function as a Group Supervisor, who will:

- Oversee two investigative units engaged in Medicaid (MA) case reviews and investigations for the purpose of revenue recovery and/or referral for civil litigation. Directly supervise two Investigating Supervisors who each supervise a team of Senior Investigators.

- Ensure eligibility reviews and determinations are completed properly and investigative casework is finished within the prescribed timeframe.

- Design, create and implement appropriate corrective active plans (as necessary).

- Provide subject matter expertise and clarifies applicable rules and/or regulations governing MICSA rules on recoveries for Spousal Support, MA Bank Match, BFI Default, MA Aid to Continue, MA Income and other MA related projects. Ensure best practices are carried out to maximize staff time to achieve best results.


- Certify that all investigative methodologies comply with HRA/DSS policy, guidelines and industry best practices.

- Monitor and track monthly assignments (in excess of 320 cases per month), for even and timely distribution to the investigative staff. Audit assignments to subordinate staff.

- Review and examine case records, reports & other information. Ensure that agency guidelines, investigative functions and appropriate workflow actions are followed.

- Determine if monthly case assignments are in concert with division management directives that will aide in meeting revenue recovery objectives.

- Monitor cases referred for civil litigation to ensure that referrals are accurate.

- Monitor subordinate time and leave. Evaluate job performance and compliance with EEO & other agency mandates. Meet with staff regularly to disseminate and discuss new and existing agency policy and procedures.

- Identify issues and address them effectively and efficiently. Offer solutions, implement and monitor corrective action plans.

- Identify training opportunities and recommend trainings for staff to assist them enhance their skill sets. Train first line supervisors as well as other subordinate in the performance of work activities. Send staff for formal training.

- Conduct and participate in individual and unit meetings to share information and assist with any departmental concerns. Monitor and track unit goals and objectives by meeting regularly with superiors and subordinates.

- Participate and represent Division at high-level meetings. Keep the division apprised of any updates on MA related and/or other procedures and policies.

- Provide guidance and additional direction to the Investigating Supervisors in determining decisions on hardship cases. Encourage and ensure that issues and/or concerns are resolved timely.

- Provide guidance on court schedules for Civil Litigation cases when witnesses need to appear in court to support legal counsel.


Work Schedule: Monday to Friday: 9 to 5

Work Location: 375 Pearl Street

ASSOCIATE FRAUD INVESTIGATOR ( - 31118

1. A four-year high school diploma or its educational equivalent and five years of satisfactory, full-time experience, acquired within the United States in one or a combination of the following: performing investigations involving criminal and/or fraudulent activities; evaluating credit histories; searching for assets; and/or researching, compiling and/or locating evidence or information in order to build a case or uncover activities of criminal, corrupt, unlawful or unethical nature involving public or private funds, one year of which shall have been in a supervisory or administrative capacity; or
2. An associate degree or 60 semester credits from an accredited college, including or supplemented by 12 semester credits from an accredited United States college in criminal justice, forensic science, police science, criminology, criminal justice administration and planning, and/or law or related field and three years of satisfactory, full-time experience as described in "1" above, one year of which shall have been in a supervisory or administrative capacity; or
3. A baccalaureate degree from an accredited college and two years of satisfactory, full-time experience as described in "1" above, one year of which shall have been in a supervisory or administrative capacity; or
4. Education and/or experience equivalent to "1", "2", or "3" above. However, all candidates must have a four-year high school diploma or its educational equivalent and have one year of supervisory or administrative experience in the areas described in "1" above. Undergraduate college credit can be substituted for experience on the basis of 30 semester credits, from an accredited college, including or supplemented by 6 semester credits in the areas described in "2" above for one year of experience.

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.