Job Description

Closing Date 2025/11/07
Reference Number MMH251030-1
Job Title Forensic Investigator
Position Type Permanent
Role Family Risk
Cluster Momentum Health
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Western Cape
Location - Town / City Cape Town
Introduction
Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities, and businesses.
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.

Experience

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

Knowledge

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

Duties & Responsibilities
Internal Process

• 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.

Client

• 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.

People

• 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.

Finance

• 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.

Competencies

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

Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

Skills Required