Fraud, Waste And Abuse Manager – Medical Scheme

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

About Our Client

Our client is a leading medical scheme based in Pretoria, dedicated to providing comprehensive healthcare benefits to its members. They are committed to innovation, quality service, and the well‑being of their clients.

The role

Fraud, Waste and Abuse Manager to lead, manage, and enhance the organisation’s fraud, waste, and abuse prevention, detection, and investigation efforts across all healthcare‑related claims and provider engagements.

Responsibilities

• Develop, implement, and oversee strategies to prevent, detect, investigate, and mitigate fraudulent, wasteful, and abusive activities for the Scheme.
• Ensure compliance with regulatory requirements, protect the Scheme’s financial integrity, and safeguard member and provider trust.

Qualifications

• Grade 12.
• Degree in Forensic Auditing, Forensic Accounting, Risk Management or related field.
• 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.

Skills

• Excellent computer skills.
• Reporting skills.
• Management skills.

Remuneration

Competitive salary commensurate with experience.

Benefits

Exceptional benefits program including 23 days of annual leave, an 8‑hour workday with a 30‑minute break, life cover, disability benefits, funeral cover, pension fund, medical aid, and more.

Office perks: free parking, Wi‑Fi, landline phone allowance, on‑site gym, subsidised meals, free refreshments, Athletics Club, Pilates, and wellness programs.

Application Process

Apply today by submitting your CV and cover letter, highlighting your experience related to the job functions and skills listed above, referencing REF FWA Manager.

If you do not hear back from us within 2 weeks of applying, please consider your application unsuccessful.