Medicaid Fraud Investigator/Special Agent

Special Agent IIIThe Consumer Protection Section of the Colorado Department of Law is seeking a skilled and experienced investigator to join the Colorado Medicaid Fraud, Abuse & Neglect Unit (MFANU) as a Special Agent III. The MFANU is dedicated to protecting Colorado's most vulnerable populations by investigating Medicaid provider fraud and patient abuse or neglect and holding those responsible accountable. This position offers a unique opportunity for an experienced law enforcement professional to apply their investigative expertise to complex criminal and civil cases, collaborate with multidisciplinary teams and law enforcement partners, and play a meaningful role in protecting public resources and safeguarding vulnerable individuals across Colorado. If you are a dedicated investigator who thrives on challenging cases and is passionate about public service and making a difference, we encourage you to apply. The Office of the Attorney General/Department of Law is the "People's Lawyer". The Attorney General, Phil Weiser, was elected by the people of Colorado and is the State's chief lawyer and law enforcement official. Our vision for the Department of Law is: "Together, we serve Colorado and its people, advancing the rule of law, protecting our democracy and promoting justice for all." Our core values and commitment to diversity, equity, and inclusion, drive our actions and demonstrate our focus on being principled public servants who are innovative and better together. The Colorado Medicaid Fraud, Abuse & Neglect Unit (MFANU) conducts civil and criminal investigations, litigation, and prosecution of fraudulent activity by Medicaid providers (such as hospitals, doctors, pharmacies, nursing homes, etc.) and of patient abuse (such as physical assault, sexual assault, homicide, and embezzlement of patient trust funds). This unit receives multiple referrals and evaluates them to determine if they warrant further investigation and criminal prosecution in state court. 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 related to Medicaid Fraud and patient abuse or neglect. The Special Agent III independently conducts complex criminal, civil, and administrative investigations involving Medicaid provider fraud and patient abuse or neglect. This position evaluates allegations, develops and implements investigative strategies, conducts interviews, analyzes complex financial, medical, and investigative information, and gathers, preserves, and evaluates evidence to support criminal prosecution and civil enforcement actions. The position works collaboratively with attorneys, investigators, analysts, and law enforcement partners; prepares comprehensive investigative reports, warrants, and litigation support materials; and provides testimony in court proceedings. Additional responsibilities include providing investigative guidance and training to other investigators and law enforcement agencies, participating in public outreach and education, and potentially serving as the MFANU's Property and Evidence Manager to ensure proper evidence handling, documentation, storage, and chain-of-custody compliance. Essential duties include, but are not limited to the following: Independently conduct complex criminal, civil, and administrative investigations involving Medicaid provider fraud and the abuse or neglect of patients in Medicaid-funded healthcare settings. Evaluate complaints and referrals to determine jurisdiction, investigative priorities, potential violations, and appropriate investigative actions. Develop and implement investigative plans and strategies, identify investigative leads, and determine the scope, direction, methods, and resources necessary to conduct thorough investigations. Investigate alleged violations of state and federal Medicaid laws, including the Colorado Medicaid False Claims Act, the federal False Claims Act, and other offenses such as theft, fraud, forgery, cybercrime, and crimes against persons. Conduct interviews with suspects, victims, witnesses, regulatory officials, and other individuals to gather information and develop evidence. Obtain, examine, and analyze complex medical, financial, billing, electronic, and other records to identify patterns of fraud, establish relevant facts, and determine the extent of potential criminal or civil wrongdoing. Obtain and execute search warrants, collect and preserve evidence, and utilize appropriate investigative techniques and resources in accordance with applicable laws and procedures. Coordinate investigative activities with attorneys, compliance investigators, forensic accountants, analysts, and local, state, and federal law enforcement agencies. Independently assess and prioritize assigned investigations based on public safety concerns, statutory deadlines, emerging evidence, and other factors affecting case progression. The following knowledge, skills, and abilities are required for this position and will be considered during the selection process, including examination and/or interview: Demonstrated organizational skills, including the ability to multi-task, prioritize tasks, and meet deadlines; Demonstrated work experience managing or leading large-scale or complex investigations; Strong oral and written communication skills, including the ability to communicate concisely and effectively; Customer service and interpersonal skills, including the ability to work on a team; Strong critical thinking and analytical skills. Applicants may redact information that identifies their age, date of birth, or dates of attendance at or graduation from an educational institution. A completed State of Colorado Application: Applicants are responsible for ensuring that the application provided is fully completed and clearly describes their education, training and experience as it relates to this position. Applications left blank or marked "See Resume" will not be considered. Writing Sample: As part of your application, please attach a writing sample. We strongly prefer an affidavit. If you do not attach this writing sample, your application will be removed from consideration. The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.