FRAUD, WASTE AND ABUSE INVESTIGATOR

Introduction

We are seeking a detail-oriented and analytical Fraud, Waste and Abuse Investigator to investigate reported cases of fraud, waste and abuse within the Scheme. The successful candidate will conduct thorough investigations, gather and assess relevant information, document findings, and provide well-founded recommendations on the appropriate outcome of each investigation. This role is critical in safeguarding the Scheme’s resources, promoting accountability, and ensuring that potential irregularities are addressed effectively.

Duties & Responsibilities

The purpose of this position is to investigate any fraude, waste and abuse matter reported to the Svcheme, and to make recommendations with regards to the outcome of investigations.

  • Investigations
  • Ad hoc engagement with service providers, health care providers and members
  • Reporting
  • Operational and Department targets

Desired Experience & Qualification

Qualification

  • Grade 12 
  • Diploma in Forensic Science/Investigation or related

 

Experience 

  • Minimum 2 years claims experience
  • Minimum 1 year forensic investigation on medical aid claims experience 

 

Additional inherent requirements

  • Advanced Certificate Fraud Examination

Interested?

Thank you for your interest in Bestmed Medical Scheme.

 

Due to the large amount of applications we receive, only shortlisted candidates will be contacted.

 

Should you not be contacted within 2 weeks of the advertisement closing date, please consider your application as unsuccessful.

 

Your CV will however be put onto our database and we will contact you should any suitable vacancies arise in future.

 

We wish you the best of luck.

 

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