Complaint / Incident Investigator

JOB SUMMARY 

This position will be responsible for investigating instances of client complaints, theft, fraud, improprieties and workplace violations. The Investigator will conduct research and personal interviews in accordance with all local, state and federal laws, and Department of Health regulations as well as company policies. The Investigator will analyze all necessary information and documentation related to the investigation. Investigators will write and document comprehensive investigative reports utilizing internal forms and database. They will provide testimonials regarding the incident and the process and/or tools utilized to identify the subject(s) and/or loss. The Investigator must also assist in providing corrective action related training in a manner consistent with Department of Health regulations, policies, procedures, quality standards, and client needs. 

MAJOR DUTIES AND RESPONSIBILITIES 
•    Applies basic knowledge to investigative instances of theft, fraud, improprieties, and workplace violations.
•    Supports the Nursing Department with complex investigations and in workplace related support for other departments i.e. Human Resources, Audit, Legal
•    Participates in corrective action and continuous improvement training of field staff as needed
REQUIRED QUALIFICATIONS 
•    Knowledge of Federal, state or local regulations relevant to the company, i.e., NY State Department of Health regulations, Federal Medicaid regulations and HIPAA, preferred
•    Working understanding of investigatory techniques and processes 
•    Excellent interpersonal, organizational, and communications skills, as well as the ability to deal with all levels of people, both inside and outside the company
•    Working knowledge and ability to electronically document notes and records 

SKILLS, ABILITIES AND KNOWLEDGE
•    Knowledge of Microsoft Outlook, Word, Excel, and PowerPoint applications (required)
•    Basic understanding of the complexities of software and networking; how the systems work together (required)
•    Must be able and willing to take initiative and handle various tasks simultaneously while working efficiently, effectively, and independently under minimal supervision and successfully complete required work
•    Ability to read and write in English and use math skills accurately to complete daily paperwork (required)
•    Accuracy and attention to detail (required)
•    Preparation and documentation of investigations for hand off to Management and governmental agencies if required 
•    Timely and accurate completion of investigative reports
•    Manage multiple types of investigations (Code of Conduct, Fraud, Compliance, Theft, and Workplace Issues)
•    Working understanding of incident reporting and case management.
•    Working knowledge of evidence handling and case building 
•    Training in interview techniques
•    Must be knowledgeable in methods used in successful investigations

RELATED WORK EXPERIENCE
•    Minimum of two years in Investigations, Audit, or similar experience such as complaint investigations, insurance claim investigations, law enforcement investigations etc.

EDUCATION 
•    Bachelor’s or higher preferred, but will consider an equivalent mix of education and experience 
•    Criminal Justice or investigation technique training / education or equivalent preferred

WORKING CONDITIONS 
•    Office environment
•    Up to 50% travel (within Erie and Niagara County) with the ability to work hours outside of normally scheduled shift with little or no advance notification required