Job Description

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 desktop investigations into allegations of fraud, waste, and abuse within the medical aid industry. Must be willing to travel on behalf of the office when required.

Requirements

Formal Qualifications

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

Specific licensing or registration

ACFE certification is advantageous.

Knowledge

Forensic Investigations.
MS Excel.
Report writing.
Medical Industry knowledge (Advantageous).

Skills

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

Experience

At least 0 - 3 years forensic or investigative experience (commercial and/or desktop).

Duties & Responsibilities

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.
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 case investigation turnaround times and the quality of 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 career development.

Finance

Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.

Competencies

Checking Things:

Is meticulous in finding errors, ensures accuracy by being thorough and checking details, produces high quality work by being detailed.

Following Procedures:

Conforms and adheres to rules, closely follows instructions and procedures, minimises risks by sticking to processes.

Upholding Standards:

Behaves ethically and justly, is discreet and maintains confidentiality, meets commitments by acting with integrity.

Examining Information:

Analyses and processes information, asks probing questions, strives to find solutions to problems.

Documenting Facts

: Writes fluently when documenting facts, understands arguments logically, focuses on finding facts.

Interpreting Data:

Interprets data rationally by quantifying issues, applies technology as a means to evaluating data, evaluates information objectively.

Conveying Self-Confidence:

Is self-assured and projects inner confidence, determines own future values and own contributions. *

Showing Composure:

Stays calm and relaxed during events, is not worried and tolerates stress levels, is composed in dealing with pressure.