Fraud, Waste & Abuse Prevention Lead – Healthcare Claims

Medical Resources Group; Pretoria; On-site; ZAR 300 000 - 400 000; Full time

Job summary

A leading medical scheme based in Pretoria seeks a Fraud, Waste and Abuse Manager to spearhead fraud prevention, detection, and investigation across healthcare claims. The ideal candidate will have a relevant degree and extensive experience in fraud management and investigations within the Medical Aid Scheme industry. This role offers a competitive salary and exceptional benefits, including 23 days of annual leave, and various office perks aimed at employee wellness.

Benefits

23 days of annual leave

On-site gym

Subsidised meals

Free parking

Wi-Fi

Landline phone allowance

Life cover

Disability benefits

Funeral cover

Pension fund

Medical aid

Wellness programs

Qualifications

• 5-7 years of experience in fraud management/investigations.
• 5 years of experience managing large-scale investigations.
• 3 years experience in a Medical Aid Scheme Industry.
• 3 years claims assessing experience.
• Valid driver’s license and reliable vehicle.

Responsibilities

• Develop, implement, and oversee strategies to prevent, detect, investigate, and mitigate fraudulent activities.
• Ensure compliance with regulatory requirements and protect the Scheme’s financial integrity.

Skills

Excellent computer skills

Reporting skills

Management skills

Education

Grade 12

Degree in Forensic Auditing, Forensic Accounting, Risk Management or related field

Job description

A leading medical scheme based in Pretoria seeks a Fraud, Waste and Abuse Manager to spearhead fraud prevention, detection, and investigation across healthcare claims. The ideal candidate will have a relevant degree and extensive experience in fraud management and investigations within the Medical Aid Scheme industry. This role offers a competitive salary and exceptional benefits, including 23 days of annual leave, and various office perks aimed at employee wellness.