Fraud Risk Specialist

2 weeks ago

Johannesburg CBD, South Africa Rand Mutual Admin Services Full time
Fraud Prevention Role at Rand Mutual Admin Services

This role involves proactive prevention and detection of suspicious and fraudulent activities in the channels, preferably at the deal stage, before claims are submitted. The Fraud Prevention Manager will identify fraud trends, partner with the group investigations teams on reported claims, and continuously develop process improvements within the RML distributions channels, particularly in the funeral segment. The role requires a keen eye for identifying patterns, strong analytical skills, and the ability to communicate fraud risks effectively both internally and to senior external stakeholders.

Fraud Risk Identification and Assessment:
Conduct risk assessments to identify potential fraud risks within the RML space. Collect and analyze data to detect fraudulent activities and identify trends or irregularities within the industries and channels that RML operates, predominantly in the funeral space. Collaborate across various teams to assess fraud risks in business processes and recommend corrective actions. Ensure that new risks are identified, reported to risk for monitoring, and that mitigating controls are implemented.

Fraud Prevention Strategies:
Develop, implement, and monitor fraud prevention programs, initiatives, and establish mitigating controls for all RML stakeholders. Create and enforce policies and procedures aimed at minimizing the risk of fraud for RML and our partners. Educate internal and external RML stakeholders on fraud prevention strategies, including conducting fraud awareness training sessions. Assess and report any vulnerability on the business systems. Provide an independent opinion on fraud weaknesses and gaps within RML, to avoid fraud risk.

Monitoring and Investigation:
Monitor and analyze transactions and activities within RML, for signs of fraud or suspicious behavior. Conduct extensive field investigations to gather information on claims syndicates and collaborate with external stakeholders. Partner with RMA group investigations teams on fraud cases that affect RML. Maintain a database of incidents and outcomes for future reference and risk analysis.

Compliance and Reporting:
Ensure all fraud risk management practices are compliant with relevant regulations and standards. Prepare and present detailed reports on fraud risks, incidents, and prevention measures to senior management and partners/stakeholders on a monthly basis. Keep up-to-date with the latest fraud prevention techniques, technologies, and regulatory requirements.

Continuous Improvement:
Review and enhance existing fraud prevention tools, techniques, and frameworks. Stay informed on emerging fraud trends, including syndicates, and implement proactive measures to safeguard the organization. Foster a culture of integrity and awareness within all teams in RML, to minimize fraud risks. Build a detection model with the data analysis obtained through past investigations and incidents, ensuring that the information gathered through investigations is embedded into the detection model. Proactively report on key insights and use these to identify opportunities for continuous improvement and innovation.

Requirements: Certified Commercial Forensic Practitioner (FP) SA (ICFP) member of the Association Certified Fraud Examiner (ACFE) NQF Level 7: Bachelors degree in Forensic Science or equivalent Diploma in Criminal Justice & Forensic Investigations / Auditing Proven track record with a minimum of 15 years' experience within risk and/or fraud investigations. At least 6 years investigations experience in a fraud/forensic investigations role within the insurance industry Minimum 3 years in a managerial position Experience in funeral insurance and funeral parlour business would be advantageous. Skills Knowledge of business policies, processes, and procedures Understanding of due diligence, accreditations, and policy onboarding processes Computer literacy: Advanced MS Word, Excel, and Outlook Good presentation skills and ability to interact with internal and external stakeholders and partners at all levels Managerial and Financial Management skills

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