Job Description
Job Listing ID:
4498284 Job Title:
Compliance/Fraud Specialist Application Deadline:
Open Until Filled Job Location:
Salem
Date Posted:
05/23/2026 Hours Worked Per Week:
Not Provided Shift:
Not Provided Duration of Job:
Either Full or Part Time, more than 6 months You may contact this employer directly.
(Obtain the contact information to print or add to your jobs.) Job Summary:
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 Job Classification:
Accountants and Auditors Access our statewide or regional occupation report for more information about wages,
employment outlooks, skills, training programs, related occupations, and more. Compensation
Salary:
Not Provided Job Requirements
Experience Required:
See Job Summary
Education Required:
None Minimum Age:
N/A Gender:
N/A
