Fraud, Waste And Abuse Manager

Dymaxa Recruitment; Pretoria; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A recruitment firm is seeking a skilled fraud management leader to ensure compliance and maintain financial integrity in the medical aid industry. You will manage fraud prevention strategies and oversee investigations related to healthcare claims. The ideal candidate should possess a relevant degree and extensive experience in fraud management and claims assessing. This position is based in Pretoria, South Africa.

Qualifications

• Grade 12 qualification.
• 5 – 7 years of experience in fraud management or investigations.
• 3 years of claims assessing experience.

Responsibilities

• Lead and manage fraud, waste, and abuse prevention initiatives.
• Implement strategies to address fraudulent activities.
• Ensure compliance with regulatory requirements.

Skills

Fraud management

Investigations

Risk Management

Claims assessing

Education

Degree in Forensic Auditing, Accounting, Risk Management

Job description

Medical Aid Industry

Duties include but are not limited to :

This position is responsible for leading, managing, and advancing the organisation’s initiatives related to fraud, waste, and abuse prevention, detection, and investigation across all healthcare-related claims and provider interactions.

The incumbent will develop, implement, and oversee strategies to prevent, detect, investigate, and address fraudulent, wasteful, and abusive activities within the Scheme.

This role is tasked with ensuring compliance with regulatory requirements, maintaining the Scheme’s financial integrity, and upholding member and provider trust.

Minimum Requirements

• Grade 12
• Degree in Forensic Auditing, Forensic Accounting, Risk Management or related fields
• 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 licence and own reliable vehicle
• Salary will be determined based on experience.