Insurance Fraud Investigator Jobs in Silver Spring, MD

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 Manager to 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 Company Overview Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco's 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters. To review Serco benefits please visit: https://careers.serco-na.com/us/en/what-we-offer . If you require an accommodation with the application process please email: or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email. Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice. Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email . Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. Pay Transparency Our Total Rewards package includes competitive pay, performance-based incentives, and benefits that promote well-being and work-life balance-so you can thrive both professionally and personally. Eligible employees also gain access to a wide range of benefits from comprehensive health coverage and health savings accounts to retirement plans, life and disability insurance, and time-off programs that support work-life balance. Program availability may vary based on factors such as contract type, location, hire date, and applicable collective bargaining agreements. Salary range: The range for this position can be found at the top of this posting. This range is provided as a general guideline and represents a good faith estimate across all experience levels. Actual base salary will be determined by a variety of factors, including but not limited to, the scope of the role, relevant experience, job-related knowledge, education and training, key skills, and geographic market considerations. For roles available in multiple states, the range may vary to reflect differences in local labor markets. In addition to base salary, eligible positions may include other forms of compensation such as annual bonuses or long-term incentive opportunities. Benefits - Comprehensible benefits for full-time employees (part-time employees receive a limited package tailored to their role): * Medical, dental, and vision insurance * Robust vacation and sick leave benefits, and flexible work arrangements where permitted by role or contract * 401(k) plan that includes employer matching funds * Tuition reimbursement program * Life insurance and disability coverage * Optional coverages that can be purchased, including pet insurance, home and auto insurance, additional life and accident insurance, critical illness insurance, group legal, ID theft protection * Birth, adoption, parental leave benefits * Employee Assistance Plan To review all Serco benefits please visit: https://careers.serco-na.com/us/en/about-us . Serco complies with all applicable state and local leave laws, including providing time off under the Colorado Healthy Families and Workplaces Act for eligible Colorado residents, in alignment with our policies and benefit plans. The application window for this position is for no more than 60 days. We encourage candidates to apply promptly after the posting date, as the position may close earlier if filled or if the application volume exceeds expectations. Please submit applications exclusively through Serco's external (or internal) career site. If an applicant has any concerns with job posting compliance, please se