Forensic Investigator

Momentum Health; Cape Town; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A healthcare organization in Cape Town is seeking a forensic investigator to perform complex investigations into fraud and abuse in the medical aid industry. The candidate will need to analyze data, conduct interviews, and potentially testify in court. A relevant degree and 3+ years of investigative experience are essential, alongside strong analytical and organizational skills. This role is crucial for maintaining compliance and delivering exceptional client service.

Qualifications

• At least 3 years of forensic or investigative experience (commercial and/or desktop).
• Medical Industry knowledge – advantageous.

Responsibilities

• Perform complex desktop investigations into allegations of fraud, waste, and abuse.
• Conduct investigative interviews with relevant parties to validate findings.
• Interpret collected data and compile comprehensive case reports.
• Testify in various legal proceedings.

Skills

Forensic Investigations

Data interpretation

Report writing

Strong time management

Organizing and coordinating skills

Education

Degree in Forensics, Compliance, Accounting, Investigations or related fields

Matric certificate

Tools

MS Excel

MS Word

Job description

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 businesses 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

The role incumbent will perform complex desktop investigations into allegations of fraud, waste, and abuse within the medical aid industry.

The successful candidate will be required to testify and give evidence in court and various regulatory disciplinary proceedings based on the case reports prepared by the candidate.

Must be willing to travel on behalf of the office when required.

Requirements

Matric certificate

Degree in Forensics, Compliance, Accounting, Investigations and Forensic Accounting, Commerce, Auditing or Forensic Auditing

Experience

At least 3 years of forensic or investigative experience (commercial and/or desktop)

Knowledge

Forensic Investigations

Data interpretation

Report writing

Medical Industry knowledge – advantageous

Duties & Responsibilities

Internal Process:

• Performing (desktop) investigations into allegations of fraud, waste, and abuse using outputs of large data sets from MS Excel and other applications.
• Conducting investigative interviews with scheme members, healthcare service providers, members, and other third parties to validate findings.
• Interpreting collected data and compiling comprehensive case reports using Ms Word.
• Reporting cases to the relevant Regulatory Bodies or to SAPS.
• Testifying in criminal proceedings against service providers or members being prosecuted by the scheme.
• Testifying and giving evidence in civil, regulatory, society etc. hearings against service providers.
• Preparing, indexing and paginating investigation packs to be assigned to legal; the Filed Investigators or Regulatory bodies.

Client:

• Build and maintain relationships with clients and internal and external stakeholders.
• Perform duties within defined turnaround times.
• Deliver on service level agreements applicable to clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
• Continuously monitor case investigation turnaround times and the quality of written reporting.
• Drive client service delivery goal achievement in line with predefined standards to ensure that clients receive the expected service levels at the expected standard.
• Provide management with relevant information to assist with managing client query processes.

People:

• Continuously develop own expertise in terms of industry and forensic investigations.
• Participate and contribute to a culture of work-centric thinking, productivity, service delivery and quality management.
• Take ownership for driving your own career development.

Finance:

• Contribute to the development of area-specific budgets to minimise expenditure, in alignment with operational plans when requested.
• Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.

Competencies

• An ability to analyse and interpret large amounts of complex data in Excel
• Strong time management skills
• Proven and exceptional organising and coordinating skills