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, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.
To review Serco benefits please visit: https://careers.serco-na.com/us/en/what-we-offer. If you require an accommodation with the application process please email: careers@serco-na.com or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.
Candidates may be asked to present proof of identity during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.
Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email Agencies@serco-na.com.
Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
Pay Transparency
Our Total Rewards package includes competitive pay, performance-based incentives, and benefits that promote well-being and work-life balance - so you can thrive both professionally and personally. Eligible employees also gain access to a wide range of benefits from comprehensive health coverage and health savings accounts to retirement plans, life and disability insurance, and time-off programs that support work-life balance. Program availability may vary based on factors such as contract type, location, hire date, and applicable collective bargaining agreements.
Salary range: The range for this position can be found at the top of this posting. This range is provided as a general guideline and represents a good faith estimate across all experience levels. Actual base salary will be determined by a variety of factors, including but not limited to, the scope of the role, relevant experience, job-related knowledge, education and training, key skills, and geographic market considerations. For roles available in multiple states, the range may vary to reflect differences in local labor markets. In addition to base salary, eligible positions may include other forms of compensation such as annual bonuses or long-term incentive opportunities. Benefits – Comprehensible benefits for full-time employees (part-time employees receive a limited package tailored to their role):
- Medical, dental, and vision insurance
- Robust vacation and sick leave benefits, and flexible work arrangements where permitted by role or contract
- 401(k) plan that includes employer matching funds
- Tuition reimbursement program
- Life insurance and disability coverage
- Optional coverages that can be purchased, including pet insurance, home and auto insurance, additional life and accident insurance, critical illness insurance, group legal, ID theft protection
- Birth, adoption, parental leave benefits
- Employee Assistance Plan
To review all Serco benefits please visit: https://careers.serco-na.com/us/en/about-us.
Serco complies with all applicable state and local leave laws, including providing time off under the Colorado Healthy Families and Workplaces Act for eligible Colorado residents, in alignment with our policies and benefit plans. The application window for this position is for no more than 60 days. We encourage candidates to apply promptly after the posting date, as the position may close earlier if filled or if the application volume exceeds expectations. Please submit applications exclusively through Serco’s external (or internal) career site. If an applicant has any concerns with job posting compliance, please send an email to: careers@serco-na.com.
