Fraud Investigator jobs in South Africa

Closing Date: 2025/03/06

Reference Number: MMH241220-5

Job Title: Forensic Investigator (Desktop) x4

Position Type: Permanent

Role Family: Risk

Cluster: Health Solutions

Remote Opportunity: Some of the time

Location - Country: South Africa

Location - Province: Western Cape

Location - Town / City: Bellville

Introduction

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings Limited, delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.

Disclaimer: As an applicant, please verify the legitimacy of this job advert on our company career page.

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

Qualifications

• 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.
• Testifying in criminal proceedings against service providers or members being prosecuted by the scheme.
• Testifying and giving 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.
• Building and maintaining relationships with clients and internal and external stakeholders.
• Performing duties within defined turnaround times and delivering on service level agreements applicable to clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Participating and contributing to a culture which builds rewarding relationships, facilitates feedback, and provides exceptional client service.
• Continuously monitoring your case investigation turnaround times and the quality of your written reporting.
• Driving client service delivery goal achievement in line with predefined standards in order to ensure that clients receive expected service levels at the expected standard.
• Providing management with relevant information to assist with managing client query processes.
• Continuously developing own expertise in terms of industry and forensic investigations.
• Participating and contributing to a culture of work-centric thinking, productivity, service delivery, and quality management.
• Taking ownership for driving your own career development.
• Contributing to the development of area-specific budgets to minimise expenditure, in alignment with operational plans when requested.
• Escalating unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.

• An ability to analyse and interpret large amounts of complex data in Excel.
• Strong time management skills.
• Proven and exceptional organising and coordinating skills.