Forensic Investigator Intern

**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, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities, and businesses.

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

**Role Purpose**
- To provide administrative support to the GEMS Claims Risk Management team in the desktop forensic investigations space.

**Requirements**:
**Qualification**:

- Matric Certificate or Equivalent
- 3 year diploma or degree in forensic science, law, risk management, auditing or any other relevant field of study

**On-the-job training / qualifications**:

- Workplace etiquette and personal branding.
- Structured training and mentorship in healthcare fraud investigations.
- Exposure to real-world casework and regulatory processes.
- Opportunities to develop analytical, problem-solving, and investigative skills.
- A stepping stone into a career in forensic investigation, healthcare fraud analytics and regulatory compliance.

**Duties & Responsibilities**

**Internal Process**:

- Support Investigators with Case Report preparation.
- Index and paginate case files, packs, and briefs for external service providers and regulators.
- Ensure accurate document management and record-keeping for investigative matters referred to service provider network.
- Load and maintain investigative filters and recon reports.
- Assist in identifying trends and irregularities in claims data.
- JIRA Complaint Coordination.
- Track and manage responses for Fraud, Waste & Abuse (FWA)-related complaints logged on JIRA.
- Liaise with internal stakeholders to ensure timely and accurate resolutions.
- Minute taking at scheme meetings.
- Scheme report compilation.
- Support the team in maintaining service level agreements (SLAs) for older and backlog cases.
- Other ad hoc responsibilities on behalf of the Team.

**Client**:

- Build and maintain relationships with clients and internal and external stakeholders.
- Deliver on service level agreements applicable to clients and internal and external stakeholders in order to ensure that client expectations are managed.
- Make recommendations to improve client service and fair treatment of clients within area of responsibility.
- Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
- Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery.
- Drive client service delivery goal achievement in line with predefined standards in order to ensure that clients receive appropriate advice and after sales service.
- Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes.

**People**:

- Positively influence and manage change and offer administrative support where required.
- Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff.
- Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management.
- Take ownership for driving career development.

**Finance**:

- Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.
- Provide input into the risk identification processes development and communicate recommendations in the appropriate forum.
- Contribute to the development of area specific budgets to minimise expenditure, in alignment with operational plans.
- Identify solutions to enhance cost effectiveness and increase operational efficiency.
- Implement and provide input into governance processes, systems and legislation within area of specialisation.
- Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.
- Provide input into the risk identification processes development and communicate recommendations in the appropriate forum.

**Competencies**
- Business Acumen
- Client/Stakeholder Commitment
- Drive for Results
- Collaboration
- Impact and Influence
- Self-Awareness and Insight
- Diversity and Inclusiveness
- Growing Talent
- Problem Solving
- Attention to detail