Position Description & Qualifications

Serco Inc. is seeking a dynamic and highly skilled professional to oversee fraud detection 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 oversight, monitoring, analysis, and technology in Serco's emerging Fraud Prevention program.

Serco is seeking a dynamic and high performing Senior Managerto play a critical role supporting Serco in the challenge of mitigating growing risk associated with healthcare benefits fraud. The Senior Manager, Fraud Prevention will be primarily responsible for supporting the delivery of counter-fraud strategy, building a team of skilled fraud investigators, managing the program's data and analytics, and supporting fraud mitigation activities within a current 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 supporting establishing fraud management policies and programs and driving 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 Citizen North America division.

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

In this role, you will:

• Lead a distributed team of investigators who examine paper and digital applications for evidence of benefits fraud and identity theft.
• Inform and communicate with Serco executives, staff, and federal partners of the latest data and trends in fraud within the boundaries of Serco's contract. Communicate effectively across departments and organizational levels to support integrity operations and initiatives.
• Manage a software driven information collection and analysis system used to track fraud and provide current data to help focus investigations, reviews, and spot checks. Test system changes to ensure performance aligns with design expectations and c issues as needed.
• Collaborate with Serco managers and staff connected to other aspects of the contract. Work with these individuals to establish and grow anti-fraud awareness, techniques, and tools within the broader Serco workforce.
• Maintain an awareness of 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 of current levels of fraud for dissemination inside and outside of Serco.
• Manage, coach, and a mentor staff.
• Perform additional duties and special projects as assigned.

To be successful in this role, you will have:

• U.S Citizenship required
• Professional credentials such as;
  • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Insurance Fraud Investigator (CIFI), Certified Internal Auditor (CIA), or similar relevant certifications
• An undergraduate degree (B.A., B.S., or equivalent) required
• Minimum 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field
• Minimum 5 years of experience in leading teams, projects, initiatives, or cross-functional groups
• Demonstrated experience managing complex investigations in a managed care or healthcare environment
• Experience in coordinating with external regulators and law enforcement agencies
• 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:

• Prior leadership of a Special Investigations Unit (SIU) or equivalent function in a health plan, government agency, or large healthcare system
• Proven knowledge of HHS, CMS, OIG, and DOJ regulatory frameworks governing health insurance programs
• Advanced Microsoft Office skills, including strong data analysis capabilities