Manager: Forensic Investigations

5 days ago

Roodepoort, Gauteng, South Africa AfroCentric Group Full time

To identify, investigate and anticipate fraudulent behaviours that impact the organisation to mitigate loss of income in all open, closed and corporate schemes. Project management and operational design; development and implementation of new forensic analytical platform and in-house case management system. Monitor adherence of new contract requirements and SLA's.

Experience

5 - 6 years' Medical Aid, criminal investigations (preferable fraud related and legal case management experience)

Qualifications

ACFE certification and/or relevant diploma/degree

What will you do

  1. Implement practical solutions that use the specialist and departmental systems and processes
  2. Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation
  3. Identify problems and develop and propose solutions to present to appropriate leader or stakeholders
  4. Ensure day to day operational support required from area of specialisation is provided to enhance performance

Cost containment

  1. Support the identification, development and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialisation
  2. Continuously review cost / benefit and Return on Investment within area of specialisation
  3. Maintain a high level of impact on other departments to support improved delivery
  4. Continually increase understanding of client and stakeholder needs, satisfaction and service delivery

Knowledge management

  1. Ensure that adequate knowledge regarding specialisation is shared as required and maintained within the research library
  2. Provide advice and / or training as required
  3. Maintain, develop and implement specialist knowledge within the day to day operations of the organisation
  4. Be a member of related professional bodies
  5. Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation

Network key relationships

  1. Engage with and provide support to the established network of internal and external expert resources and partners

Specialist support to projects

  1. Provide Specialist expertise and ensure best practice related to specialisation is implemented in projects, when required
  2. Conform to project management disciplines when participating in projects
  3. Represent department or project on appropriate committees related to area of specialization

Drive customer centricity:

  1. Conduct accurate, detailed and evidence based investigations
  2. Develop detailed, business implementable recommendations on findings from investigations

Position Specific Outputs

  1. Identify potential and actual process and system weaknesses that could lead to fraudulent activity and increase the organisational risk.
  2. Conduct accurate, detailed and evidence based investigations.
  3. Develop detailed, business implementable recommendations on findings from investigations.
  4. Ensure case notes and other investigation administration requirements are kept up to date and implemented at the required standards and within SLA.
  5. Present investigated cases to relevant organisations and bodies for appropriate action to be taken.
  6. Manage extraordinary discipline-based projects resulting from scheme requests.
  7. SLA monitoring and adherence to new contract requirements with Bonitas and Polmed.
  8. Assistance with formal Monthly Quality assurance process implemented to ensure adherence to processes implemented following the s59 inquiry and adherence to newly implemented SLAs for Bonitas.
  9. Management of NOC bench for receipt of internal and external fraud referrals.
  10. Ongoing quality assurance through review of exception reports.
  11. Team leader role to individuals in the forensic team on Admin level.
  12. Conduct system and process training for new staff as well as ongoing refresher training for existing staff including awareness of newly implemented processes.
  13. Representation with scheme meetings and preparation of reporting requirements.
  14. Project management and operational design as well as development and implementation of the new forensic analytical platform and the in-house case management system.

Attributes

  1. Ownership: Make critical decisions based on what's right for AfroCentric and Customers - Owning operational decisions and knowing oneself
  2. Credibility: Lead with integrity and trust others as you would like to be trusted - Living the values and being transparent
  3. Entrepreneurship: Take chances to continuously improve our Customer's experiences - Driving operational efficiencies
  4. Influence: Engage with Customers and colleagues to advance the organisation's welfare - Making work happen
  5. Collaboration: Build work-related network and share knowledge with colleagues - Building networks

Skill

  1. Relevant systems knowledge and application
  2. Business Writing Skills
  3. Communication Skills
  4. Task Management
  5. Data modelling and evaluation
  6. Knowledge and application of relevant legislation
  7. Problem solving and decision making skills
  8. Attention to Accuracy and Detail
  9. Numerical Ability
  10. Customer Focus
  11. Knowledge and application of Forensic Investigations

Our Commitment to Transformation

AfroCentric is committed to transformation and embracing diversity. Our Employment Equity plan and targets will be considered as part of the recruitment process. This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create an inclusive workforce, representative of the demographics of our society as well as people with disabilities.

Should you not hear from us within a month of applying, consider your application unsuccessful.

Seniority level

Mid-Senior level

Employment type

Full-time

Job function

Analyst, Management, and Research

Industries

Public Health

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