Counter-Fraud Operations Lead

About the role

Serco 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 the Headquarters office in Herndon, VA. Reporting to the Senior Manager, Fraud Prevention, the role manages the operational flow, coordination, documentation, and quality control of matters entering and moving through the Fraud Prevention function, serving as the primary operational control point for Fraud Prevention work.

Responsibilities

• 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.

Requirements

• U.S. Citizenship
• Bachelor's degree
• At least five years of experience in fraud investigations, healthcare program integrity, compliance, law enforcement, investigative operations, case management, or a related field
• Must be local to the