Working Title: Senior Investigator - Pharmacy
Job Class: Human Services Program Representative 2
Agency: Human Services Dept
Job ID : 90721
Location : St. Paul
Telework Eligible : Yes
Full/Part Time : Full-Time
Regular/Temporary : Unlimited
Who May Apply : Open to all qualified job seekers
Date Posted : 12/09/2025
Closing Date : 12/22/2025
Hiring Agency/Seniority Unit : Human Services Dept / MAPE DHS Central Office
Division/Unit : Department of Human Services (DHS) / Office of Inspector General (OIG)-PIO MPAI Investigators 3
Work Shift/Work Hours : Day Shift / 8:00 a.m. - 4:30 p.m.
Days of Work : Monday - Friday
Travel Required : Yes
Salary Range: $32.40 - $47.76 / hourly; $67,651 - $99,722 / annually
Classified Status : Classified
Bargaining Unit/Union : 214 - MN Assoc of Professional Empl/MAPE
FLSA Status : Nonexempt
Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : Yes
The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.
The work you'll do is more than just a job.
At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.
*This position is eligible for telework (https://mn.gov/mmb-stat/policies/1422-telework.pdf) for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.
*Approximately, 10% travel.
This position exists to provide health, accounting, law enforcement and/or criminal justice system experience to combat waste, mismanagement, misuse, fraud, and abuse in the Minnesota Medical Assistance program. The employee will function independently and as a member of an investigation team, in training, developing and implementing strategies toward fraud detection, comprehensive investigations, and the development of cases that may involve civil, monetary, or criminal case actions. In addition, the employee will plan, develop, and implement strategies that are designed to minimize the opportunities for program abuse.
The position requires the employee independently investigate and assist other investigative staff to initiate, develop, and resolve cases which lead to administrative actions, sanctions, referrals for criminal action, and/or monetary recoveries of county, state and federal funds erroneously or fraudulently received by providers or medical services to clients of Medical Assistance. These functions are the major responsibilities of this position.
Minimum Qualifications
To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.
Three (3) years of experience reviewing and/or submitting pharmacy claims to the Minnesota Medical Assistance program.
AND
Experience must demonstrate the following:
Registered Pharmacist with the Minnesota Board of Pharmacy or a Certified Pharmacy Technician with the Pharmacy Technician Certification Board.
Experience with claims analysis, audits, or healthcare investigations.
Develop audit approaches, chart reviews or verification checks for use in evaluating data to identify cases needing further review.
Analyze fiscal and/or statistical data and identify discrepancies, claim patterns, and trends.
Working knowledge of relevant state pharmacy laws, NCPDP billing standards, DEA rules, and/or third-party payor responsibilities.
Preferred Qualifications
Broad-based, comprehensive understanding of federal and state health care policy, rules, laws and requirements that allow for making and/or denying payment of claims adjudicated the Medicaid claims processing system.
Understanding of claims the processing operations, claims forms, edits and coding structures sufficient to be able to understand the procedures followed and decisions made by claims processing staff.
Experience in retail, specialty, or long-term care pharmacy operations.
Knowledge of medical terminology and coding.
Presenting concise, well-written, factual, investigative reports, referrals, and other materials for legal review and consideration in civil or criminal cases.
Some working knowledge of Word, Excel and the basic computer programs used by MPAI.
The ability to learn the data warehouse and other analytical tools.
Effectively communicate with persons involved in cases, minimizing conflict and de-escalating conflict should it arise.
Writing legal and technical documents, i.e., Notices of Agency Action, correspondence, policies, procedures and statistical/fiscal information.
Variety of experiences working effectively with others from different backgrounds and cultures.
Additional Requirements
This position requires successful completion of the following:
It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:
Criminal background check
Reference check
Fingerprinting check (MNJIS/CJIS)
Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3-business days from the start of employment; and successfully obtain/retain CJIS certification annually.
AN EQUAL OPPORTUNITY EMPLOYER
Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status.
Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email careers@state.mn.us . Please indicate what assistance is needed.
