Position Purpose: To identify, investigate, and assist in the prevention of fraud, waste and abuse within the medical aid environment. This includes but is not limited to analysing healthcare provider claims, member behaviour and internal operations to mitigate financial and reputational risks.

Experience: Extensive Experience (3-5 years) in forensic investigation, with demonstrated expertise in gathering evidence, analysing data and leading investigations.

Qualification: Degree or diploma in Forensics, CFE.

KEY PERFORMANCE AREAS

• Identify and investigate suspected fraudulent and irregular claims or transactions.
• Conduct interviews, gather evidence, and compile forensic reports.
• Liaise with healthcare and other service providers, members, internal departments, regulatory bodies and external law enforcement where required.

Data Analysis

• Analyse claims data to ident...