Position Description & QualificationsSerco Inc. is seeking a highly-organized and experienced Counter-Fraud Operations Lead to support the Fraud Prevention function on a large federal healthcare contract at our Headquarters office in Herndon, VA. Reporting to the Senior Manager, Fraud Prevention, this role is responsible for managing the operational flow, coordination, documentation, and quality control of matters entering and moving through the Fraud Prevention function.
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 team's 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 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.
Must be local to the DMV (D.C, Maryland, Virginia) area.
In this role, you will:
- Manage Fraud Prevention intake and triage processes and ensure incoming matters satisfy established referral and acceptance criteria.
- Maintain the Fraud Prevention work queue and provide visibility into workload, ownership, status, aging, priority, 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:
- 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 skills and demonstrated ability to manage priorities, deadlines, dependencies, 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 work effectively across investigative, analytical, operational, technical, and management functions
- Strong analytical and problem-solving skills
- Ability to travel up to 10% as needed
Additional desired experience and skills:
- Experience supporting healthcare fraud, health insurance, federal benefits programs, or government program integrity.
- Knowledge of 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 you are interested in supporting the CMS program, apply today!
