Fraud Prevention Strategy Lead—Healthcare

Serco; Dumfries (VA); On-site; USD 140,000 - 190,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Life insurance

401(k) with employer match

Paid time off

Job summary

Serco Inc. is seeking a Senior Manager to oversee fraud detection, escalation, and risk operations for a large federal contract at its HQ in Herndon, VA.

You will lead monitoring, analysis, and supportive technology for Serco’s Fraud Prevention program, collaborating across departments and with federal partners to mitigate identity and eligibility fraud. You will forge a strategic fraud framework, manage complex investigations, and grow anti-fraud capabilities with strong leadership and

Qualifications

• 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
• 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 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

Responsibilities

• Provide program integrity and fraud expertise to inform Serco executives, staff, and federal partners of the latest data and trends in fraud and potential 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 escape 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, growing anti-fraud awareness and tools within the 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
• Keep current on evolving and emerging healthcare fraud issues and liaise with federal/state/local/private sector counterparts
• 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

Skills

Fraud detection

Data analytics

Leadership

Stakeholder management

Project coordination

Communication

Education

B.A./B.S. or equivalent

Tools

Microsoft Office

Job description

Serco Inc. is seeking a Senior Manager to oversee fraud detection, escalation, and risk operations for a large federal contract at its HQ in Herndon, VA.

You will lead monitoring, analysis, and supportive technology for Serco’s Fraud Prevention program, collaborating across departments and with federal partners to mitigate identity and eligibility fraud. You will forge a strategic fraud framework, manage complex investigations, and grow anti-fraud capabilities with strong leadership and