Fraud, Waste and Abuse Manager – Medical Scheme

Medical Resources Group (Pty) Ltd; Pretoria; On-site; ZAR 300,000 - 400,000; Full time

Job summary

A leading medical scheme in Pretoria is seeking a Fraud, Waste and Abuse Manager to enhance fraud prevention, detection, and investigation efforts. This role requires 5-7 years of experience in fraud management and a degree in a relevant field. The successful candidate will ensure compliance and protect the financial integrity of the scheme. Attractive salary and benefits, including an exceptional leave policy and various office perks.

Benefits

23 days of annual leave

On-site gym

Subsidized meals

Free parking

Wi-Fi

Wellness programs

Qualifications

• Grade 12 qualification.
• 5 - 7 years of experience in fraud management/investigations.
• 3 years experience in a Medical Aid Scheme Industry.

Responsibilities

• Lead, manage, and enhance fraud prevention and detection efforts.
• Develop and oversee strategies to mitigate fraudulent activities.
• Ensure compliance with regulatory requirements.

Skills

Excellent computer skills

Reporting Skills

Management Skills

Education

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

Our client is seeking a Fraud, Waste and Abuse Manager to join their team on a permanent basis. The successful candidate will be responsible 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.

Functions

• 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.
• Responsible for developing, implementing, and overseeing strategies to prevent, detect, investigate, and mitigate fraudulent, wasteful, and abusive activities for the Scheme.
• The role ensures compliance with regulatory requirements, protects the Scheme’s financial integrity, and safeguards member and provider trust.

Skills

• Excellent computer skills
• Reporting Skills
• Management Skills.

Requirements

• 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 drivers license and own reliable vehicle

Remuneration

• Competitive salary commensurate with experience.
• Exceptional benefits program including 23 days of annual leave, 8-hour workday with a 30min 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, subsidized meals, free refreshments, Athletics Club, Pilates, and wellness programs.
• Dynamic team interactions, recognition programs, and incentives.

Join Our Client

Be part of a team that values innovation, quality service, and the well-being of its members. Apply today to contribute to a leading medical scheme's success and make a difference in the lives of many.

Application Process

Interested candidates should submit their CV and cover letter, highlighting their experience related to the job functions and skills listed above to [e-mail] with REF FWA Manager. If you do not hear back from us within 2 weeks of applying, please consider your application unsuccessful.