Fraud, Waste and Abuse Manager

16 hours ago


Pretoria, Gauteng, South Africa Medpharm Recruitment Full time

A Medical Aid based in Pretoria is seeking a Fraud, Abuse and Waste Manager to join their Corporate Governance team.

Job Purpose:

  • Manage, and enhance the organisation's fraud, waste, and abuse prevention, detection, and investigation efforts across all healthcare-related claims and provider engagements.
  • Responsible for developing, implementing, and overseeing strategies to prevent, detect, investigate, and mitigate fraudulent, wasteful, and abusive activities for the Scheme.
  • The role ensures compliance with regulatory requirements, protects the Scheme's financial integrity, and safeguards member and provider trust.

Requirements:

  • Grade 12
  • Degree in Forensic Auditing, Forensic Accounting or Risk Management
  • 5 years of experience in managing large scale investigations within Fraud Management
  • 3 years experience in a Medical Aid Scheme Industry
  • 3 years Claims assessing experience
  • Valid Drivers license and own reliable vehicle


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