Forensic Investigator (Desktop) x4 MMH241220-5

Role Purpose

The role incumbent will perform complex desktop investigations into allegations of fraud, waste, and abuse within the medical aid industry. The successful candidate will be required to testify and give evidence in court and various regulatory disciplinary proceedings based on the case reports prepared by the candidate. Must be willing to travel on behalf of the office when required.

Requirements

• Matric certificate
• Degree in Forensics, Compliance, Accounting, Investigations and Forensic Accounting, Commerce, Auditing or Forensic Auditing

• At least 3 years of forensic or investigative experience (commercial and/or desktop)

• Forensic Investigations
• Data interpretation
• Report writing
• Medical Industry knowledge - advantageous

• Performing (desktop) investigations into allegations of fraud, waste, and abuse using outputs of large data sets from MS Excel and other applications.
• Conducting investigative interviews with scheme members, healthcare service providers, members, and other third parties to validate findings.
• Interpreting collected data and compiling comprehensive case reports using MS Word.
• Reporting cases to the relevant Regulatory Bodies or to SAPS.
• Testify in criminal proceedings against service providers or members being prosecuted by the scheme.
• Testify and give evidence in civil; regulatory; society etc. hearings against service providers.
• Preparing, indexing and paginating investigation packs to be assigned to legal, the Filed Investigators or Regulatory bodies.
• Build and maintain relationships with clients and internal and external stakeholders.
• Perform duties within defined turnaround times Deliver on service level agreements applicable to clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
• Continuously monitor your case investigation turnaround times and the quality of your written reporting.
• Drive client service delivery goal achievement in line with predefined standards in order to ensure that clients receive expected service levels at the expected standard.
• Provide management with relevant information to assist with managing client query processes.
• Continuously develop own expertise in terms of industry and forensic investigations.
• Participate and contribute to a culture of work-centric thinking, productivity, service delivery and quality management.
• Take ownership for driving your own career development.
• Contribute to the development of area specific budgets to minimise expenditure, in alignment with operational plans when requested.
• Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.