Specialist: Forensic Investigation

Job Advert Summary

An exciting permanent position exists for an analytical and results driven team player. The successful candidate will be responsible for assisting the Business in minimising risks to the company and to achieve the company’s strategic objectives. In this way ensuring that effective controls are in place and are adhered to.

Minimum Requirements

• Matric
• Business related qualification (Forensics or equivalent).
• Certified Fraud Examiner (CFE) is desirable.
• Medical Scheme Administration Experience, 1-2 years essential.
• Experience in a similar role is desirable.
• 2+ years' experience in working in the healthcare/insurance or banking environment
• Forensic background would be an advantage.
• Data Analytics exposure will be an advantage
• 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, can-do attitude.
• Ethical and able to maintain confidentiality and manage boundaries.
• Confident and professional manner.
• Articulate, both verbally and writing.
• Objective, logical and enquiring mind.
• Strong analytical and problem-solving skills.
• Good project management and team working ability
• Good time Management.
• Must be able to work independently and under pressure.

Duties and Responsibilities

Forensics Investigations:

• Must assist in detecting and investigating fraud and suspected fraud and abuse within PPS, from initiation to finalisation of court cases. This would include the interviewing of witnesses and suspects as well as the examination of supporting evidence and documentation
• Assisting with the investigation of leads
• Must be able to perform investigations
• Ability to assess and interpret evidence, maintain the investigation's integrity, evaluate results and determine the cause, analyse the circumstance and make valid recommendations.
• Must be able to perform investigations so that the image of PPS is not detrimentally affected.
• Execute and actively participate in investigations
• Compiling case dockets for criminal prosecution and produce an investigative reporting

Stakeholder Management:

• Responsible for claims investigations within the agreed time frame / SLA
• To provide the Claims department with properly investigated cases that will enable the assessors or requester to assess the claim and pay valid claims

Data & Reporting

• Must be able to formulate data extracts and analysis to detect invalid claims and create data intelligence ability to ensure preventative management of claims investigations
• Preparing comprehensive audit and forensic reports, as may be required regarding action to be taken regarding the investigation.