State of Arizona :


Job Information
Job Reference ID:  54164 
Grade:  19 
Posted Date:  04/09/2020 
Close Date:   
Job Description


Arizona Health Care Cost Containment System

Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork



Fraud Investigator - Tucson


First Review: February 28, 2020

This position will remain open until filled


Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility.


All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results. State employees are highly engaged, collaborative and embrace a culture of public service.  Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!



The Office of Inspector General is looking for a highly motivated individual to join our team as a Fraud Investigator - Tucson location . This position conducts field investigations to evaluate the accuracy of eligibility determinations for state and federal programs to prevent ineligible applicants from being approved. Major duties and responsibilities include but are not limited to:


Traveling, Interviewing, gathering data and developing sources of information


Review and assess information in the case record; analyze data obtained from all sources, case development, assessing the accuracy of the application, determining expenditures for cost benefit analysis and writing investigative summaries.


Planning, scheduling, prioritizing work activity; set up workload controls, determine priorities, and monitor activity progress, set goals.


Studying statutes, rules, policy manual and clarifications, attending training and conferring with supervisor and others to improve skills and maintain expert level of knowledge.


Participate in special projects that may include out of town travel involving residency/eligibility checks of participants as well and on-site audits of certain high risk Medicaid providers.



Must have knowledge of claims reporting activity, Microsoft Windows software, Excel spreadsheet software, basic understanding of data base software, Medicaid Programs and Prepaid Medical Management Information System (PMMIS) and/or DES Eligibility System (AZTECS)


Expert knowledge of State statute, rules and regulation relating to the determination  of eligibility for AHCCCS   programs, legal and technical terminology for the interpretation of highly diverse forms of verification including, but  not limited to, divorce decrees, county property assessment records, medical records, hospital billings, life insurance policies, public assistance benefits and self-employment records.


Skilled in analyzing case records, evaluation and interpretation  of written and verbal information, troubleshooting and problem solving skills, research methodologies, independent working skills (requiring a minimum of supervision), interviewing  techniques to elicit information, effective verbal and written communication, basic computer skills, interpersonal relations as applied to contact with benefit recipients, landlords, employers, public and private organization representatives, the use of tactful diplomacy due to the political nature of the job.


Ability to work within a team environment, function effectively in an orderly and purposeful manner in situations of stress or tension, work with the public in less than ideal conditions, deal with multiple tasks at one time.





Knowledge in the rules regarding the admissibility of statements, admissions and confessions.  Knowledge of Title 19 and ASRS title 13 & 36



At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan. Click here to learn more about benefits.


Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4678. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.

Click the APPLY NOW button to submit your application.

For technical assistance, email [email protected] or call 602-542-4700.


Position Requirements
Position Level:    Hours:   
 Work Arrangement:     Employment Type:   
Hourly Rate:  $0.00 / per hour  Salary:  $35,000.00-43,000.00 


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