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Business Compliance Auditor & Program Integrity Specialist (Pfml Specialist 3)

Expired Job

State Of Washington Lacey , WA 98503

Posted 2 months ago

Description

Here at Employment Security, we believe in the Power to Help when people need it most. We provide economic security to the people of Washington every day and in every corner of the state. We help people find jobs, bridge gaps in employment and soon we'll be providing paid family medical leave.

The newly formed Paid Family and Medical Leave division is looking to hire a Business Compliance Auditor and Program Integrity Specialist. In this role, you will play a critical role in quality assurance and program compliance. Investigations will identify program compliance gaps and result in recommendations for improvement, changes that will strengthen program policies and process, and increased compliance that will minimize potential fraud.

It is estimated that up to 2/3 of Washingtonians will have an event that results in them being eligible for Paid Family and Medical Leave. Working on the Paid Family and Medical Leave Team means you get to help create a people-centered, accessible, and cutting-edge program that will benefit millions of Washington workers and employers for generations. If our mission motivates you, please apply to be a part of our team!

Duties

Identify and investigate potential risks and reported claims of fraud and abuse. You will represent the department at administrative hearings and recommend changes to Paid Family and Medical Leave procedures to improve agency services.

Some of what you'll be doing:

  • Reviewing processes to ensure compliance with program laws, regulations, policies and procedures, and recommend changes for improvement.

  • Perform quality assurance audits, make recommendations for changes to correct deficiencies, evaluate corrective actions to ensure compliance.

  • Investigate fraudulent or illegal business practices, including irregularities with premium collections and reporting, claimant wage discrepancies, and reported leads received by the division.

  • Evaluate evidence, prepare and review investigative reports, determine rebuttal requirements and/or need for additional facts, present evidence and adjudicate law violations in accordance with state statutes.

  • Process requests for administrative hearings and appeals, prepare cases for presentation, and represent the department in administrative hearings.

  • Make recommendations for grievances, complaints and appeals; work with management to enact findings; recommend changes to agency procedures to improve access to agency services.

Qualifications

Required qualifications:

A Bachelor's degree in a health or social science, public or business administration, political science, or a related field AND two years of experience examining and/or processing loan applications, medical insurance or rehabilitation claims, insurance claims, collection of insurance premiums, tax collection or providing staff support in financial eligibility determination

OR

One year of experience equivalent to the PFML Specialist 2 with another state that administers a paid family medical leave program.

OR

A combination of education and/or relevant experience.

Preference will be given to those applicants that have the following:

Internal and external investigations and compliance testing of operational policies, laws, rules, regulations and/or financial transactions.

Supplemental Information

Please attach a resume and letter of interest to your on-line application (through the Add Attachment(s) field).

  • Applications with comments such as "see attachments" in the supplemental question responses will be considered incomplete.

Other Information

  • As a condition of employment, the successful candidate accepting this position must comply with the Union Security clause contained in the Collective Bargaining Agreement between the State of Washington and the Washington Federation of State Employees.

  • Final external candidates must be able to pass an Unemployment Insurance (UI) Fraud check.

  • This recruitment may be used to establish a qualified pool of ESPC3 candidates for like agency-wide vacancies in the next six months.

  • The Employment Security Department is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities.

  • If you are having technical difficulties creating, accessing or completing your application, please contact careershelp@des.wa.gov or (360) 664-1960 or toll free (877) 664-1960.

Veteran's Preference

Applicants who meet the minimum qualifications and wish to claim Veteran's Preference must attach a copy of their DD214 or other verification of military service. Please black out any personally identifiable data such as social security numbers.

Thank you for your service!

Modern Workplace

ESD's employee engagement scores were up 8 percent to 71 percent in 2017 and we continue to develop programs to improve the employee experience. We are working to create a modern workplace designed to meet the needs of a changing workforce. We have wellness programs, telework policies and flexible schedules. We're working to update our facilities all over the state to enhance both the client and employee experience.

Opportunity for All

The Washington Employment Security Department is an equal opportunity employer. We strive to create a working environment that includes and respects cultural, racial, ethnic, sexual orientation and gender identity diversity. Women, racial and ethnic minorities, persons of disability, persons over 40 years of age, veterans or people with military status, and people of all sexual orientations and gender identities are encouraged to apply.

Please contact the Carolyn Haley on the Talent Acquisition Team at 360-480-5752, chaley@esd.wa.gov, HRRecruiting@esd.wa.gov or Washington Relay Service 711 if you are a person with a disability needing assistance in the application process, if you need this job announcement in an alternate format, or with general questions about this opportunity.


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Business Compliance Auditor & Program Integrity Specialist (Pfml Specialist 3)

Expired Job

State Of Washington