HireMO

Position Description & Qualifications

Serco Inc. is seeking a highly-organized and experienced Counter-Fraud Operations Lead to support the fraud mitigation function on a large federal healthcare contract at our Headquarters office in Herndon, VA. Reporting to the Fraud Prevention Senior Manager, this role is responsible for managing the operational flow, coordination, documentation, and quality control of matters entering and moving through the Fraud identification, escalation, and mitigation processes.

The Counter-Fraud Operations Lead will serve as the primary operational control point for Fraud Prevention work. The position will manage intake and triage, coordinate assignments and priorities, maintain visibility over the program's fraud-related work queue, monitor case status and aging, enforce case-management and documentation standards, conduct first-line Fraud Prevention operational quality-control review, and coordinate routine handoffs with other Serco and client functions.

This position works closely with technical, operational, investigative and analytical personnel but performs a distinct function: Fraud Analytics personnel identify patterns and relationships across cases and data; Investigators are responsible for developing case-level facts and findings; the Counter-Fraud Operations Lead ensures accepted work moves through a controlled and consistent lifecycle from intake through documented finding, recommended disposition, escalation, referral, or closure in accordance with established Serco and client authorities and procedures.

The successful candidate will bring strong operational judgement, exceptional organizational discipline, experience managing complex investigative or fraud-related workflows, and ability to rapidly assimilate new knowledge. The individual must be able to identify incomplete referrals, competing priorities, stalled matters, quality issues, and workflow bottlenecks and take appropriate action to keep work moving while escalating significant substantive or programmatic issues to the Senior Manager.

Prefer candidate to be local to the DMV (D.C, Maryland, Virginia) area.

In this role, you will:

+ Manage fraud mitigation intake and triage processes and ensure incoming matters satisfy established referral and acceptance criteria.

+ Maintain the fraud work queue and provide visibility into workload, ownership, status, aging, priority, escalations, and next actions.

+ Coordinate assignment of accepted matters to investigative and analytical personnel based on priority, complexity, capability, and workload.

+ Track matters throughout the Fraud Prevention lifecycle and identify stalled work, approaching deadlines, unresolved dependencies, and operational impediments.

+ Establish and maintain consistent case-management, documentation, and workflow standards.

+ Conduct first-line Fraud Prevention operational quality-control review for completeness, consistency, documentation, and adherence to established procedures.

+ Ensure Fraud Prevention work is documented, handled, and maintained in accordance with applicable client and Serco privacy, security, records-management, and information-handling requirements.

+ Coordinate routine handoffs, referrals, and information exchanges between Fraud Prevention and other Serco and client functions.

+ Ensure significant findings, recommended dispositions, escalations, and referrals are appropriately documented and routed.

+ Maintain operational metrics relating to intake, workload, timeliness, aging, disposition, referral activity, and quality.

+ Identify recurring process deficiencies and recommend changes to workflows, controls, referral criteria, documentation requirements, and operating procedures.

+ Support implementation of Fraud Prevention procedures, templates, controls, and case-management tools.

+ Work closely with fraud analytics and investigative personnel to ensure case-level findings and operational lessons are captured for broader fraud-prevention use.

+ Provide the Senior Manager, Fraud Prevention with operational reporting and identify matters requiring management attention or escalation.

+ Perform additional duties and special projects as assigned.

To be successful in this role, you will have:

+ U.S Citizenship

+ Ability to obtain and/or maintain a public trust

+ An undergraduate degree (B.A., B.S., or equivalent) required.

+ At least five years of experience in fraud investigations, healthcare program integrity, compliance, law enforcement, investigative operations, case management, or a related field.

+ Demonstrated experience managing investigative, compliance, fraud, or case-management workflows involving multiple concurrent matters.

+ Experience with intake, triage, assignment, case tracking, quality control, disposition, escalation, referral, and closure processes.

+ Strong organizational and project management skills with demonstrated ability to manage priorities, schedules, milestones, dependencies, resource constraints, and competing workloads

+ Strong professional judgement and the ability to distinguish routine operational issues from matters requiring substantive or management escalation.

+ Experience establishing or applying documentation and quality-control standards.

+ Excellent written and verbal communication skills.

+ Demonstrated ability to lead and coordinate cross-functional efforts across investigative, analytical, operational, technical, and management functions to achieve program objectives

+ Strong analytical and problem-solving skills.

Additional desired experience and skills:

+ Experience supporting healthcare fraud, health insurance, federal benefits programs, or government program integrity audits or oversight organizations (General Accounting Office, Inspecter General).

+ Project Management Professional (PMP), Certified Associate in Project Management (CAPM), Agile, Scrum, or other project management certifications are preferred.

+ Knowledge of federal healthcare programs, processes, or contractor environments.

+ Experience developing or implementing investigative workflows, case-management procedures, referral criteria, or operational controls.

+ Familiarity with fraud indicators, typologies, investigative methods, and analytical processes.

+ Experience developing operational metrics, dashboards, or management reporting.

+ Experience coordinating matters involving federal agencies, regulators, law-enforcement organizations, or government contractors.

+ Advanced Microsoft Office skills, including strong data analysis capabilities.

If interested in supporting CMS, apply today!

Company Overview

Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco's 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, t...

Apply Externally

Jobs

Counter-Fraud Operations Lead

Summary

You Need a MO Jobs Account First

Jobs

Jobs

Counter-Fraud Operations Lead

Summary

Do You Have a MO Jobs Account?

First, Let's Find Your MO Jobs Account

Create an Account to Apply

You Need a MO Jobs Account First

HireMO Terms of Use

1. Acceptance and Changes

2. A No-Cost Public Workforce Service

3. Eligibility, Youth, and Authority

4. Accounts and Security

5. Accuracy Attestation and Program Information

6. Job Seeker Terms

7. Employer Terms

8. Assessments and Matching

9. Artificial Intelligence Features

10. Public Records and Required Notices

11. User Content and Permissions

12. Acceptable Use

13. Intellectual Property and Government Marks

14. Other Users and Third-Party Services

15. Electronic Communications

16. Suspension, Termination, and Records

17. Disclaimers

18. Limitation of Liability and Sovereign Immunity

19. Employer Indemnification

20. Governing Law and General Terms

21. Contact, Accessibility, and Complaints