Position Description & QualificationsSerco Inc. is seeking a dynamic and highly skilled professional to oversee fraud detection, escalation, and risk operations for a large federal contract at our Headquarters office in Herndon, VA. Reporting to the Director of Program Management, this role is responsible for coordination and oversight of monitoring, analysis, and supportive technology in Serco's emerging Fraud Prevention program.
Serco is seeking a dynamic and high-performing Senior Manager to play a critical role supporting Serco in mitigating the challenges and growing risks associated with health insurance coverage verification, including identity and eligibility fraud. The successful candidate will be primarily responsible for supporting the delivery of counter-fraud strategy, managing the program's fraud data and analytics, and supporting fraud mitigation activities within the operations of Serco's contract. The position ensures timely and effective investigation, mitigation and response, and provides management with reports, insights and recommendations based on application of advanced data analysis and up-to-date knowledge of industry best practices on fraud detection, prevention, and mitigation.
In addition to anticipated daily oversight, management, and incident review, the individual will play a critical strategic role in establishing fraud management policies and programs. The individual will work across operational, technical and compliance teams to drive adoption of industry-leading practices and technologies, introducing new processes, and growing a fraud prevention culture within Serco's workforce.
The successful candidate will thrive in a fast-paced, deadline-driven environment and consistently demonstrate strong technical expertise, professional judgment, and the ability to rapidly assimilate new knowledge. This position interfaces regularly with stakeholders in the U.S. federal government and in Serco's North America division.
Must be local to the DMV (D.C, Maryland, Virginia) area. In this role, you will: - Provide program integrity and fraud expertise to inform Serco executives, staff, and federal partners of the latest data and trends in fraud and potential application or impact on the program.
- Evaluate program rules, operational processes, and systems and assess risk and mitigations strategies based on current trends/best practices.
- Design and incorporate a strategic fraud framework into program processes, operations, and program integrity functions and systems.
- Lead and coordinate a distributed, cross-functional team that will examine, identify, detect and escalate applications, supporting documentation, or communication related to program verification for patterns of eligibility or identity fraud.
- Communicate effectively across departments and organizational levels to advise and support program integrity and fraud mitigation operations and initiatives.
- Collaborate with Serco managers and staff connected to other aspects of the program. Work with these individuals to establish and grow anti-fraud awareness, techniques, and tools within the broader Serco workforce.
- Manage complex, cross-cutting projects involving multiple functional areas to implement program integrity and fraud mitigation projects.
- Develop and oversee a software driven information collection and analysis system to track fraud and provide current data to focus investigations, reviews, and spot checks. Test system changes to ensure performance aligns with design expectations and resolve issues as needed.
- Keep current on evolving and emerging healthcare fraud issues and incidents, liaise with federal, state, local, and private sector counterparts to understand emerging fraud tactics and techniques.
- Generate written and oral reports and presentations of current levels of fraud for dissemination inside and outside of Serco.
- Build relationships and customer intimacy with government clients and potential partners to support program integrity and fraud mitigations projects and initiatives.
- Manage, coach, and mentor staff.
- 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)
- At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, government auditing or oversight, or related fields
- At least 5 years of experience in leading integrated teams, projects, initiatives, or cross-functional groups
- Demonstrated experience managing complex investigations and/or audits in a healthcare coverage environment or government programs
- Experience with compliance technology platforms and advanced data analytics for fraud detection
- Excellent communication skills, both verbal and written; ability to tailor communication to technical and non-technical audiences
- Strong and interpersonal skills to work in a team-oriented environment
- Strong leadership, stakeholder management and influencing skills
- Strong organization skills with the ability to multitask and prioritize; ability to work under pressure and to tight deadlines.
- Strong analytical and problem-solving skills. Excellent communication and interpersonal skills, with the ability to collaborate effectively across departments and organizational levels.
Additional desired experience and skills: - Professional credentials desired, such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Insurance Fraud Investigator (CIFI), Certified Internal Auditor (CIA), or similar relevant certifications.
- Prior leadership of a Special Investigations Unit (SIU), oversight group, or equivalent function in a large healthcare system, health plan, or government agency (Government Accounting Office, Office of Inspector General, etc.).
- Proven knowledge of HHS, CMS, OIG, and DOJ regulatory frameworks governing health insurance programs.
- Advanced Microsoft Office skills, including strong data analysis capabilities.
if you are interested in working at Serco and supporting CMS, apply today!
