Description
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Forensic Officer

Duties and Responsibilities
Responsibilities:

* Participates in developing policies and procedures to prevent fraudulent activities and recover any incurred losses.
* Participates in planning and undertaking various statistical exercises designed to highlight over-servicing and manipulation of tariffs by service providers and members.
* Prepares monthly statistical returns on several cases under investigation.
* Alerts the Client Experience Manager on instances of system weaknesses which facilitate irregular practices and suggest methods of correcting such weaknesses.
* Investigates and prepares preliminary reports on information security and submits to the Client Experience Manager monthly.
* Carries out compliance reviews and submits a report on findings to the Client Experience Manager.
* Updates and maintains the Vulnerability Management Programme, including establishing mechanisms to identify new vulnerabilities and changes in the threat landscape.
* Research, analyse, and identify emerging global industry trends that relate to Medical Aid Fraud.
* Maintenance of the drug file system, checks, and verifies whether scheme rules are correctly loaded on the system.
* Oversees and participates in the development of analytics models to assess and identify anomalous trends relating to Medical Aid Claims and overall business operations.
* Identifies and reviews monthly claims analysis, data received from claims department and Internal Audit reports to manage anomalies.
* Oversee and participate in the development of analytic models to assess and identify anomalous trends relating to Medical Aid Claims and overall business operations. HiringManagement Consultants

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Qualifications and Experience
Qualifications and Skills:

* A degree in Forensic Audit or Insurance and Risk Management.
* Relevant knowledge of the medical aid industry is a must.
* At least 3 years experience in a similar role.