06/01/1989 07402

CLAIMS INVESTIGATION AGENT

DEFINITION:

This is professional work in the investigation and settlement of public assistance related claims, and the collection, review and analysis of technical information used in the establishment and enforcement of child support orders.

An employee in this class is assigned functions investigating, settling claims, recovering funds legally owed to the Commonwealth; prosecuting public assistance clients that fraudulently received benefits; conducting the technical and regulatory review of cases that are subject to departmental administrative fair hearings; and/or collecting, reviewing, analyzing, interpreting and explaining child support orders for the Department of Public Welfare. Work may include independent responsibility for the preparation of prosecution packages and testimony and the presentation of cases in civil and criminal proceedings to prosecute recipient fraud cases. Work involves applying Federal and state mandates, policies and procedures in the child support enforcement, restitution and reimbursement activities by searching local court house records, county assistance office files and financial records of public assistance clients. Work also includes: reviewing claims referrals; collecting and analyzing information for determining feasibility for investigating, locating, encumbering and obtaining resources for the prosecution and settlement of claims against present and former public assistance clients, legally responsible individuals or organizations providing contracted services to welfare program clients; or establishing paternity and enforcing child support orders for individuals responsible for dependent public assistance clients. Work may also include coordinating program activities with such other agencies as the Internal Revenue Service, Social Security Administration, Bureau of Employment Security, Bureau of Motor Vehicles, and county judiciary and domestic relations offices; and responding to inquiries or complaints associated with the programs administered through the Bureau of Child Support Enforcement. Duties may also involve the preparation of witnesses for recipient fraud cases; the coordination of cases scheduled for administrative hearings; and the technical review of decisions for impact on departmental policies and procedures. Work is performed in accordance with mandates, policies and procedures, requires discretion and judgment in conducting investigations, preparing cases and evidence and implementing reimbursement restitution, or prosecution actions. Work is performed under the general direction of a supervisor who evaluates work performance through conferences, review of reports and results achieved in meeting established goals and objectives.

EXAMPLES OF WORK:

Applies and enforces mandates of the child support enforcement, reimbursement or restitution program activities by investigating and settling claims; recovering erroneously provided public welfare benefits and services; and assembling and presenting cases in prosecution for fraud.

Investigates claims referrals by collecting and analyzing information on individual claims, determines feasibility for pursuing the investigation and establishes liability and takes steps to encumber financial resources through the use of property liens, wage attachments and other legal actions and makes recommendations as to terms for the settlement of legal claims for the Department.

Interprets laws and policies regarding claims to debtors, attorneys, public officials, realtors, legally responsible individuals, court officials, domestic relations officials and others and cooperates with local county and welfare officials in claims investigation and settlement on child support enforcement activities.

Reviews hearings decisions for impact on departmental policies and procedures, and makes recommendations to modify departmental operational procedures or appeal the hearing officer's decision.

Responds to complaints and inquiries from Federal and state officials, legislators, attorneys, child support staff from other states, welfare clients, defendants, plaintiffs and the general public regarding Bureau of Child Support Enforcement programs.

Provides assistance, instructions and training to county domestic relations office staff in the proper completion of forms necessary for compliance with Federally mandated child support programs.

Gathers information through Commonwealth and out-of-state courts, child support staff, employers and the postal service to locate legally responsible parents and obtain information on their income and assets in order to insure the enforcement of child support orders.

Negotiates for the recovery of funds lawfully owed to the Commonwealth by present and former public assistance recipients, contracted service providers or legally responsible individuals for welfare services and benefits provided.

Assembles, prepares and presents evidence and prepares witnesses for prosecution of fraud cases in civil and criminal proceedings or serves as witness for prosecution.

Coordinates Office of Fraud Abuse and Investigation hearing activities by tracking and reviewing hearings conducted for timeliness; insuring departmental attendance; reviewing hearings decisions to insure adherence to departmental procedures.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES:

Ability to learn the methods, processes and procedures for investigating and settling claims for the restitution or reimbursement for erroneous payments for services and benefits for public assistance clients; or for determining the appropriate and available resources for establishing and enforcing child support orders for responsible individuals and parents of public assistance clients.

Ability to establish and maintain cooperative work relationships with public assistance clients, service provider groups, associates, public and private officials, court officials, realtors and county assistance office staff to obtain and share information relating to the investigation and settlement of claims for the recovery of funds lawfully owed to the Department.

Ability to learn the principles and practices of real estate appraisal and management in order to establish liens for the restitution of overpayments for benefits and services for public assistance clients.

Ability to negotiate with debtors, service provider groups, attorneys, Domestic Relations officers and the courts to secure payment of claims or adequate child support orders for overpayments for services and benefits provided to public assistance clients.

Ability to locate legally responsible individuals and parents of dependent public assistance clients through appropriate agencies.

Ability to gather and present evidence or testify in administrative hearings, or civil or criminal court proceedings.

Ability to exercise judgment and to make decisions which are in compliance with applicable mandates.

Ability to prepare comprehensive reports and to make clear and concise statements orally and in writing.

MINIMUM EXPERIENCE AND TRAINING:

Four years of investigative public contact experience requiring the review and presentation of records, correspondence and documents used in the prosecution of cases, approval of claims or credit, or collection of debts;

or

A bachelor's degree in Pre-law, Criminal Justice, Police Science, or a closely related field;

or

Any equivalent combination of experience and training.