Claims Risk Analyst

3 weeks ago


Cape Town, South Africa Health Solutions Full time

**Introduction**
- Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.

**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.

**Role Purpose**

**Requirements**:

- Matric
- Relevant degree / diploma in Forensics or Accounting is advantageous
- 3 years’ experience in forensics or investigating experience is essential
- Drivers License is essential
- Willingness to travel on behalf of the office when required is essential
- In-depth knowledge/ understanding of various claims methods is essential
- Knowledge of Forensic Investigations is essential
- Ability to compile clinical forensic reports for clients is essential
- Knowledge of the regulatory legislation of the Health Care industry is advantageous
- Knowledge of provider billing behaviour and patterns is advantageous

**Duties & Responsibilities**
- Investigating fraud cases allocated in terms of the required protocols
- Using data analysis techniques to detect potential fraud
- Using data visualization software to enhance investigations
- Compilation of comprehensive forensic case reports
- Liaising with relevant Societies and or Medical Advisors
- Reporting cases to relevant Regulatory Bodies and / or SAPS
- Assisting with Claims specific projects
- Committing to developing knowledge
- Pre-analytics and maintenance of outliers
- Engagements providers /members
- Testing new rules requirements FWA (error codes and system testing)

**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


  • Forensic Planner

    2 weeks ago


    Cape Town, South Africa TRS Staffing Full time

    Cape Town SA Role Purpose To work with internal Project Planning Teams to ensue project schedules, records and reports are setup and maintained in accordance with contractual requirements, internal best practices, enabling the preparation of prospective and retrospective delay and disruption analyses, providing effective delay and disruption claims advice,...

  • Risk Analyst

    2 weeks ago


    Cape Town, South Africa Metropolitan Life Full time

    **Introduction** Metropolitan is one of the oldest financial services brands in South Africa. With a 125-year legacy of serving the communities in which it operates, Metropolitan represents true empowerment in serving Africa's people through affordable financial solutions that create financial growth and security. Metropolitan operates in South Africa, but...


  • Cape Town, South Africa Health Solutions Full time

    **Introduction** **Role Purpose** The role incumbment will assist the Claims Risk Specialist with the management and recovery of benefit debt. This includes benefit overpayments and recovery per agreed acknowledgement of debt agreements concluded on behalf of the scheme. **Requirements**: **Education**: - Matric or equivalent qualification - BCom degree...

  • Risk Analyst

    4 weeks ago


    Cape Town, South Africa Health Solutions Full time

    **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,...

  • Junior Risk Analyst

    9 months ago


    Cape Town, South Africa Job Crystal Full time

    A dynamic, innovative and inspiring company providing fintech solutions across multiple sectors is looking for a Junior Risk Analyst, who will report to the Senior Risk Analyst. The Junior Risk Analyst plays a pivotal role in assessing, analysing, and mitigating risks within the company where Merchant Cash Advances (MCAs) are offered to small and medium...

  • Sports Risk Analyst

    3 weeks ago


    Cape Town, South Africa Initiate International Full time

    A leading land based operator is expanding portfolios and they have exciting opportunities in their brand new iGaming venture. They have an amazing **job** opportunity for a **Sports Risk Analyst** to join their in **Johannesburg**. You will create and settle sports events, operating live platform. If you are analytical with a great interest and knowledge in...


  • Cape Town, South Africa RGA Full time

    **Position Overview** The Claims Administration Team is looking for a self-motivated individual who has at least 2 years administration experience to manage the incoming claims and work allocation across the team. The role will require interaction with internal and external clients in response to queries; loading of claims notifications onto the system; and...


  • Cape Town, South Africa Health Solutions Full time

    **Introduction** **Role Purpose** The role incumbent will be responsible for managing and guiding a team focused on proactive risk identification, by bringing a systematic and structured approach to adjudicating financial risk to client schemes. Activities will be directed at preventing future losses due to Fraud, Waste, and Abuse (FWA) primarily in the...

  • Senior Risk Analyst

    7 months ago


    Cape Town, South Africa Job Crystal Full time

    A dynamic, innovative and inspiring company providing fintech solutions across multiple sectors is looking for a Senior Risk Analyst, who will report to the Risk Manager. The Senior Risk Analyst plays a pivotal role in assessing, analysing, and mitigating risks within the company where Merchant Cash Advances (MCAs) are offered to small and medium...


  • Cape Town, South Africa Efficient Frontier Recruitment Full time

    Top rated Asset Manager has an interesting “**_hybrid_**” Market Risk / Performance Analyst opportunity available for an **experienced** Investment Quant. The role includes many of the typical responsibilities of a Senior Performance Analyst, but with a strategic Market Risk focus. This is an excellent opportunity for a numbers person who is passionate...


  • Cape Town, South Africa Truworths Full time

    **Motivation**: Recruitment for Merchant Training Programme As a Trainee Risk Analyst, you have the amazing opportunity for an entry level role with plenty of growth opportunities! Truworths, South Africa's leading retailer is looking for a BBusSci/BSc/Act Sci or Bcom Investment graduate (strong Mathematics/ Statistics) with strong academic record to join...


  • Cape Town, Western Cape, South Africa CA Financial Appointments Full time

    Senior Risk Analyst PositionCA Financial Appointments is seeking a highly skilled Enterprise Risk Analyst Lead to join our team. The successful candidate will have extensive experience in risk management and strong analytical skills.Job Overview:The Senior Risk Analyst will assist with risk processes, including reporting, optimization, assessment,...


  • Cape Town, South Africa Crisis24 Full time

    At Crisis24, A GardaWorld Company, we take a proactive approach to solving business challenges and our customers are at the heart of everything we do. It’s the reason we love rolling up our sleeves and getting down to work - and it’s why we’re so successful. It takes an entire team to stand behind something big. Interested? About Crisis24 Crisis24, is...

  • Claims Analyst

    7 months ago


    Cape Town, South Africa Engen Full time

    **Purpose of the Job**: To fulfil all aspects of demurrage (import/export/coastal), including claims for other Divisions, Chemical and Lubricants. To be responsible for the vessel vetting nominations for the company and to review the Vetting Policy. To co-ordinate and report on all demurrage, marine, insurance and legal claims within Supply & Trading Dept...

  • Risk Analyst

    4 days ago


    Cape Town, South Africa CA Financial Appointments Full time

    A well known, Financial Services giant, with offices both in Cape Town & Johannesburg, is in search of a soon to be CA(SA) or a Recently Qualified CA(SA) to get the opportunity to fill a Risk Analyst role. This role will support and work closely with the Chief Risk Officer in driving effective risk management practices across a multifaceted insurance...

  • Risk Analyst

    3 days ago


    Cape Town, South Africa CA Financial Appointments Full time

    A well known, Financial Services giant, with offices both in Cape Town & Johannesburg, is in search of a soon to be CA(SA) or a Recently Qualified CA(SA) to get the opportunity to fill a Risk Analyst role. This role will support and work closely with the Chief Risk Officer in driving effective risk management practices across a multifaceted insurance...

  • Claims Analyst

    6 days ago


    Cape Town, South Africa Engen Full time

    **Purpose of the Job**: To identify value enhancement activities within Supply Chain, monitor and recommend solutions to enhance the berth utilisation, review the vessel vetting policy for the company and the optimum choice of 3rd party vetting contractor and co-ordinate & review all aspects of commercial (import/export) and coastal demurrage, including...

  • Credit Risk Analyst

    7 months ago


    Cape Town, South Africa PayFast Full time

    Payfast by Network, together with the DPO Group, is one of the leading Fintech organisations in Africa. We’re on a mission to exponentially grow the digital economy of Africa by building world-class payment products. Developed in-house, our solutions enable customers to make and receive business payments quickly and securely and allow enterprises to trade...


  • Cape Town, South Africa Unifi Recruitment Full time

    **Job Advert Summary**: **Unifi** is a fast-growing finance and technology company operating in Zambia, South Africa, Uganda and Kenya. Unifi delivers personal lending products through online, mobile phone and branch channels. The company is well supported by strong shareholders and a board of directors with vast experience in entrepreneurship and...


  • Cape Town, South Africa BigTalent Full time

    **Attention**:Experienced Credit Risk Analysts!** Are you ready to take your career to the next level? Do you thrive in dynamic environments where your expertise makes a significant impact? If so, we have an exciting opportunity for you! Join our esteemed team at one of the leading financial institutions in the industry. As a Senior Risk Analyst, you will...