Internal Control Investigator

1 week ago

Johannesburg, South Africa PPS Recruitment Full time

**Job Advert Summary**:
**Purpose and Scope of the Job**:
The incumbent will be responsible for the investigation of fraud and will form part of the PPS Short Term Insurance Investigations Team with sound knowledge of Life Insurance, Internal Control/Forensics area. The incumbent will report to the Technical Operations Manager in the STI Business.

**Minimum Requirements**:
**Education**:

- Bachelor’s Degree in Forensic or equivalent
- Certified Fraud Examiner (CFE)
- Relevant post graduate degree will be advantageous

**Experience**:

- 5 years’ experience in similar role
- Experience in working in the insurance or banking environment

**Knowledge and Skills**:

- Strong communication skills (written & verbal)
- Strong networking and relationship building (Internal & external)
- Strong analytic and problem-solving skills
- Adaptability to different stakeholders, audiences, and environments
- Data analysis (conversant with pivot tables and other analysis tools)
- Ability to evaluate, identify and assess trends and patterns requiring further investigation
- Ability to present case using the relevant presentation tools
- Interpersonal skills to persuade and ensure compliance with established methods, models and concepts of investigation, to discussion among authorities involved in an investigation and reconcile differing interpretation of evidence
- Ready to work in a challenging environment

**Interpersonal and Intrapersonal Skills**:

- Advanced forensic investigation capability and strategy implementation
- Identification of fraudulent activity / behaviour
- Formulation of investigation with other stakeholders (audit/HR/Insurance)
- Adapting and responding to change
- Commercial Acumen
- Persuading and Influencing
- Deciding and Initiating Action
- Collaboration

**Duties and Responsibilities**:
**Forensics Investigations**
- Must provide assistance in detecting and investigation of fraud and suspected fraud and abuse within PPS Group, from initiation to finalisation of court cases. This would include the interviewing of witnesses and suspects as well as the examination of supporting evidence and documentation
- Assisting with the investigation of leads
- Must be able to perform specialised investigations
- Ability to assess and interpret evidence, maintaining the integrity of the investigation, evaluating results and determining cause, analyse the circumstance and make valid recommendations.
- Must be able to perform investigations in such a way that the image of PPS is not detrimentally affected.
- Execute and actively participate in complex investigations
- Internal Auditing on claims, processes, service providers
- Look at processes of Prevention and Deterrence of Fraud
- Compiling case dockets for criminal prosecution
- Produce an investigative reporting and tracking of criminal cases
- Documenting and tracking of all open cases

**Stakeholder Management**
- Responsible for claims investigations within the agreed time frame / SLA
- To provide the relevant departments with properly investigated cases that will enable the assessors or requester to assess the claim and pay valid claims

**Data & Reporting**
- Must be able to formulate data extracts and analysis to detect invalid claims and create data intelligence ability to ensure preventative management of claims investigations
- Do research on best practices and new trends in the industry
- Conduct audits and fraud risk assessments where necessary, report findings or deviations and assist in implementing recommended controls
- Preparing comprehensive audit and forensic reports, as may be required to make regarding action to be taken regarding the investigation
- Prepare reports for different departments or upper management

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