Special Agent- 00229477 na Georgia Department of Community Health, GA

About the Department

Pay Grade: LI

The Georgia Department of Community Health (DCH) is one of Georgia's four health agencies serving the state's growing population of over 10 million people. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (SHBP) and Healthcare Facility Regulation, impacting one in four Georgians.

Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and under-served populations. Six enterprise offices support the work of the agency’s three program divisions. DCH employees are based in Atlanta, Cordele and across the state. 

DCH is committed to providing superior Customer Service and Communication, embracing Teamwork and fostering Accountability to ensure that our internal and external customers and stakeholders feel included, respected, engaged and secure.  

Under supervision, trains to investigate alleged or suspected violations of federal, state or local laws, rules and regulations to determine if evidence is sufficient to recommend prosecution or to report findings to the appropriate jurisdiction authority or licensing board for action. Investigations may be conducted under both administrative and criminal authority, depending on the nature of the alleged violation.

Position Duties

• Under general supervision, investigates alleged or suspected violations of federal, state, or local laws, rules, and regulations—including the Georgia Dental Practice Act and Board rules—to determine if evidence is sufficient to recommend prosecution or to report findings to the appropriate jurisdictional authority or licensing board for action  
• Distinguishes between cases requiring administrative versus criminal investigative processes to ensure the integrity and admissibility of collected evidence
• Exercises both administrative and criminal investigative authority as appropriate to the nature and scope of each case  
• Manages an active caseload of approximately 10–20 cases at various stages of investigation
• Obtains and verify evidence by interviewing or observing witnesses, complainants, and licensees; analyzing documents and records; and conducting site visits or inspections  
• Subpoenas treatment records, medical documentation, and other relevant materials necessary for investigative review
• Conducts background investigations and gathers information relevant to licensing or disciplinary decisions  
• Collaborates with other agencies and authorities on joint investigative activities such as surveillance, transcription, and research 
• Assigns patient and peer review cases to qualified consultants for evaluation. • Facilitates the review of treatment records by cognizant Board members or assigned experts  
• Utilizes investigative software and case management systems to create case numbers, track activities, store evidence, and organize financial and supporting documentation 
• Communicate professionally with licensees, complainants, peer reviewers, and Board members regarding case details and progress  
• Acknowledges receipt of complaints and responds to status inquiries in a timely manner  
• Prepare thorough investigative summaries and reports that detail the findings and support any recommended action
• Maintains investigative files in accordance with state retention schedules and confidentiality policies 
• Ensures the strict confidentiality of all information related to complaints, investigations, and protected health information.  
• Prepares and submits monthly reports summarizing the status and progression of investigative cases  
• Trains to identify relevant case issues and determine the type of evidence needed to support or refute allegations
• Performs other duties as assigned

Minimum Qualifications

Bachelor's degree in a related field from an accredited college or university AND must meet the prerequisites and complete the Basic Law Enforcement Training Program certification; or Two (2) years of experience in law enforcement or related field and Georgia P.O.S.T. certification. 

Note: Some positions may require the incumbent to have a valid Class C driver's license.

Preferred Qualifications: 

• Three (3) to five (5) years of investigative experience, including criminal investigations within a law enforcement agency 
• Three (3) to five (5) years of experience leading and directing law enforcement activities 
• At least one (1) year of experience in regulatory compliance or working within a regulatory agency 
• Demonstrated experience managing a caseload of 20–30 cases per month on average 
• Experience planning and conducting interviews of witnesses, complainants, and subjects 
• Experience gathering information, writing, obtaining, and executing search warrants 
• Strong experience writing clear, detailed, and comprehensive investigative reports 
• Proven ability to manage multiple tasks and prioritize competing deadlines
• Investigative experience in one or more of the following specialized areas: Financial crimes, including insurance fraud, Medicaid/Medicare fraud, Forgery and document fraud, Cybercrimes and OSINT 
• Experience conducting investigations involving white-collar crime or complex fraud schemes

Other Qualifications

EARN MORE THAN A SALARY! In addition to a competitive salary, the Georgia Department of Community Health offers a generous benefits package, which includes employee retirement plan; paid holidays annually; vacation and sick leave; health, dental, vision, legal, disability, accidental death and dismemberment, health and child care spending account.

Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered, but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification. 

THIS POSITION IS SUBJECT TO CLOSE AT ANY TIME ONCE A SATISFACTORY APPLICANT POOL HAS BEEN IDENTIFIED. APPLICATIONS WITHOUT WORK EXPERIENCE LISTED WILL NOT BE CONSIDERED. CURRENT GEORGIA STATE GOVERNMENT EMPLOYEES WILL BE SUBJECT TO STATE PERSONNEL BOARD (SPB) RULE PROVISIONS. THE POSITION MAY BE FILLED AT A LOWER OR HIGHER POSITION LEVEL.

This position is unclassified and employment is at-will. Candidates for this position are subject to

a pre-employment background history and reference check. For more information about this job

contact: http://dch.ga.gov

Georgia P.O.S.T. Records Requirement:

You must submit a complete and current transcript of your Georgia Peace Officer Standards and Training (P.O.S.T.) history and training records, including your Officer Profile page. The 'Fact Sheet' must be generated from the Officer Demographic Page, stamped with the date of the submitted application and clearly reflect your certification status when printed.