Fraud, Waste and Abuse Manager

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

Job summary

A healthcare organization in Pretoria is seeking a Fraud, Waste, and Abuse Manager to lead initiatives related to fraud prevention and investigation. Candidates should have a degree in forensic auditing or related fields, along with 5-7 years of fraud management experience. The role also involves ensuring compliance and maintaining the financial integrity of the organization.

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.

Responsibilities

• Leading, managing, and advancing the organisation’s initiatives related to fraud, waste, and abuse prevention.
• Developing, implementing, and overseeing strategies to prevent, detect, and investigate fraudulent activities.
• Ensuring compliance with regulatory requirements and maintaining financial integrity.

Skills

Fraud management

Investigations

Risk management

Education

Degree in forensic auditing, forensic accounting, risk management or related fields

Job description

Fraud, Waste and Abuse Manager - Pretoria

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 12Degree 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. Please