Job Details
Compliance/Fraud Specialist
**Position Description & Qualifications**
Serco is seeking a Compliance/Fraud Specialist to join our talented and fast-paced Advisory Services team, which supports federal programs assisting millions of people seeking government health insurance coverage. This dynamic position on the Compliance team will primarily work on the CMS Eligibility Support (ES) Contract supporting external audits, conducting internal compliance reviews, and developing mitigation strategies to address and triage errors.
**Job Summary**
The Compliance/Fraud Specialist supports program integrity, compliance monitoring, and fraud risk management activities for the Eligibility Support (ES) program. This role focuses on conducting compliance and fraud-focused reviews, identifying risks and trends, and supporting internal reviews, external audits and CMS directed program integrity efforts. The Compliance/Fraud Specialist works cross-functionally with Quality Assurance (QA), Operations, and Program leadership to define review criteria, analyze consumer records, assess compliance with policies, Standard Operating Procedures (SOPs), and CMS requirements, and escalate potential compliance or fraud risks as appropriate.
This position is part of a cross-cutting program integrity review team and is well suited for candidates with experience in Quality Assurance (QA), Affordable Care Act (ACA) Marketplace, Eligibility Support programs, or related compliance and fraud prevention programs.
**In this role you will:**
+ Conduct compliance, fraud and program integrity reviews to ensure adherence to internal processes, SOPs, Document Verification Guides (DVGs), and CMS requirements
+ Define review criteria and methodologies for compliance and program integrity assessments
+ Pull, analyze, and review records, applications, and supporting documentation to evaluate compliance with eligibility verification and program requirements
+ Identify trends, patterns, anomalies, and potential compliance or fraud-related risks
+ Document review findings clearly and accurately, including root causes and risk impacts
+ Support program integrity and fraud risk management efforts by identifying potential fraud indicators, high?risk submissions, or anomalous activity
+ Participate in risk?based monitoring activities, including enhanced document integrity checks and pattern recognition
+ Assist with escalation of potential program integrity, compliance, or fraud concerns following established processes
+ Contribute to recommendations for process improvements, controls, or tools to mitigate identified risks
+ Assist in assessing risk and impact for identified compliance or integrity issues
+ Maintain accurate records and documentation to support reporting and follow?up activities
+ Support internal compliance reviews and external government audits by gathering requested information and documentation
+ Assist with responses to external audit findings within required timelines
+ Collaborate with QA, operations, and leadership teams to align compliance activities with program requirements
+ Share insights and findings to support continuous improvement of eligibility verification and compliance processes
**To be successful in this role, you must have:**
+ U.S. Citizenship
+ Bachelor's degreein business, Healthcare Administration, Public Administration, Criminal Justice, Information Systems, or a related field (experience may be substituted in lieu of degree)
+ 3 years experience in compliance, quality assurance, program integrity, fraud identification or eligibility support
+ Knowledge of ACA Marketplace and/or Eligibility Support (ES) programs
+ Experience reviewing records, applications, or documentation against defined criteria or requirements, including Document Verification Guides (DVGs) and Standard Operating Procedures (SOPs)
+ Strong analytical skills with the ability to identify patterns, trends, and risks
+ Strong attention to detail and documentation skills
+ Ability to interpret policies, procedures, and guidance and apply them consistently
+ Strong written and verbal communication skills
+ Ability to travel up to 10%
**Preferred Qualifications**
+ Prior QA experience within ACA Marketplace or ES programs
+ Experience supporting audits or compliance reviews
+ Familiarity with fraud risk indicators or program integrity monitoring
+ Experience working with CMS?directed initiatives or government program oversight
+ Ability to work independently and manage multiple reviews or priorities
If you are interested in supporting and working with our passionate Serco team - then submit your application now for immediate consideration. It only takes a few minutes and could change your career!
**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: careers@serco-na.com 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 Agencies@serco-na.com .
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 send an email to: careers@serco-na.com .
Serco is seeking a Compliance/Fraud Specialist to join our talented and fast-paced Advisory Services team, which supports federal programs assisting millions of people seeking government health insurance coverage. This dynamic position on the Compliance team will primarily work on the CMS Eligibility Support (ES) Contract supporting external audits, conducting internal compliance reviews, and developing mitigation strategies to address and triage errors.
**Job Summary**
The Compliance/Fraud Specialist supports program integrity, compliance monitoring, and fraud risk management activities for the Eligibility Support (ES) program. This role focuses on conducting compliance and fraud-focused reviews, identifying risks and trends, and supporting internal reviews, external audits and CMS directed program integrity efforts. The Compliance/Fraud Specialist works cross-functionally with Quality Assurance (QA), Operations, and Program leadership to define review criteria, analyze consumer records, assess compliance with policies, Standard Operating Procedures (SOPs), and CMS requirements, and escalate potential compliance or fraud risks as appropriate.
This position is part of a cross-cutting program integrity review team and is well suited for candidates with experience in Quality Assurance (QA), Affordable Care Act (ACA) Marketplace, Eligibility Support programs, or related compliance and fraud prevention programs.
**In this role you will:**
+ Conduct compliance, fraud and program integrity reviews to ensure adherence to internal processes, SOPs, Document Verification Guides (DVGs), and CMS requirements
+ Define review criteria and methodologies for compliance and program integrity assessments
+ Pull, analyze, and review records, applications, and supporting documentation to evaluate compliance with eligibility verification and program requirements
+ Identify trends, patterns, anomalies, and potential compliance or fraud-related risks
+ Document review findings clearly and accurately, including root causes and risk impacts
+ Support program integrity and fraud risk management efforts by identifying potential fraud indicators, high?risk submissions, or anomalous activity
+ Participate in risk?based monitoring activities, including enhanced document integrity checks and pattern recognition
+ Assist with escalation of potential program integrity, compliance, or fraud concerns following established processes
+ Contribute to recommendations for process improvements, controls, or tools to mitigate identified risks
+ Assist in assessing risk and impact for identified compliance or integrity issues
+ Maintain accurate records and documentation to support reporting and follow?up activities
+ Support internal compliance reviews and external government audits by gathering requested information and documentation
+ Assist with responses to external audit findings within required timelines
+ Collaborate with QA, operations, and leadership teams to align compliance activities with program requirements
+ Share insights and findings to support continuous improvement of eligibility verification and compliance processes
**To be successful in this role, you must have:**
+ U.S. Citizenship
+ Bachelor's degreein business, Healthcare Administration, Public Administration, Criminal Justice, Information Systems, or a related field (experience may be substituted in lieu of degree)
+ 3 years experience in compliance, quality assurance, program integrity, fraud identification or eligibility support
+ Knowledge of ACA Marketplace and/or Eligibility Support (ES) programs
+ Experience reviewing records, applications, or documentation against defined criteria or requirements, including Document Verification Guides (DVGs) and Standard Operating Procedures (SOPs)
+ Strong analytical skills with the ability to identify patterns, trends, and risks
+ Strong attention to detail and documentation skills
+ Ability to interpret policies, procedures, and guidance and apply them consistently
+ Strong written and verbal communication skills
+ Ability to travel up to 10%
**Preferred Qualifications**
+ Prior QA experience within ACA Marketplace or ES programs
+ Experience supporting audits or compliance reviews
+ Familiarity with fraud risk indicators or program integrity monitoring
+ Experience working with CMS?directed initiatives or government program oversight
+ Ability to work independently and manage multiple reviews or priorities
If you are interested in supporting and working with our passionate Serco team - then submit your application now for immediate consideration. It only takes a few minutes and could change your career!
**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: careers@serco-na.com 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 Agencies@serco-na.com .
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 send an email to: careers@serco-na.com .
Job #NLX292134212