Specialist:forensic Investigator - Centurion, South Africa - PPS Recruitment

PPS Recruitment
PPS Recruitment
Verified Company
Centurion, South Africa

1 week ago

Thabo Mthembu

Posted by:

Thabo Mthembu

beBee Recruiter
Description

Job Advert Summary:

Applications are invited for the above-mentioned position, to be filled as soon as possible.


Minimum Requirements:


Qualifications & Experience

  • Matric
  • Business related degree (Forensics/Internal Audit/Commercial).
  • Certified Fraud Examiner would be advantageous.
  • Medical Scheme Administration Experience, 5 years essential.
  • Forensic Auditing/Internal Auditing is essential.
  • Ability to work cohesively in a team environment and balance multiple priorities.
  • A team player who can work alone when required and without supervision.
  • High level of attention to detail, resilience, enthusiasm, energy and drive.
  • Positive, cando attitude.
  • Ethical and able to maintain confidentiality and manage boundaries.

Duties and Responsibilities:


  • Investigating allegations of healthcare fraud against providers.
  • Investigation of fraud cases received via Whistleblowers and internally.
  • Following up on leads regarding allegations of healthcare fraud.
  • Using CAAT's, identify claims that have been processed incorrectly.
  • Conducting investigations into all aspects pertaining to healthcare fraud.
  • Instituting measures to prevent fraud.
  • Engaging perpetrator/s and taking necessary action where applicable.
  • Analysing data to identify possible fraudulent trends i.e. coding, drugs analysis etc.
  • Supply feedback to the Group Manager with regards to forensic audit findings.
  • Compile monthly savings report and submit to Group Manager.
  • Perform internal audit as and when required.
  • Liaise with scheme clients on the outcome of the investigation.

Additional tasks and responsibilities:


  • Mend the RFMCF fraud line.
  • Doing administrative tasks.
  • Adhoc requests
  • Confident and professional manner.
  • Articulate, both verbally and writing.
  • Objective, logical and enquiring mind.
  • Strong analytical and problemsolving skills.
  • Good project management and team working ability
  • Good time Management.
  • Must be able to work independently and under pressure.
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