FWA & Healthcare Claims Risk Manager

Momentum; Bellville; Hybrid; ZAR 900,000 - 1,300,000; Full time

Job summary

Momentum Health is seeking an experienced risk management leader to guide a team focused on proactive risk identification in the prepayment domain, using structured forensic methodologies to mitigate fraud, waste, and abuse. The role oversees analysis of healthcare provider claims, identifies anomalies, and recommends mitigations to the client team.

The position requires strong people leadership, data analytics expertise, and collaboration across cross-functional teams, with hybrid office-based

Qualifications

• Matric or equivalent qualification.
• Minimum 5 years experience in Risk Management, Audit, Compliance, or financial forensic services.
• Experience in managing people in cross-functional teams.
• Experience in conducting desktop investigations and risk assessments using forensic methodologies.
• Experience in data analysis and/or data analytics (Essential).
• Experience in Financial Crime Compliance or in complex forensic investigations (Advantageous).
• Knowledge of Fraud, Waste, and Abuse regulatory environment.

Responsibilities

• Develop understanding of the internal environment aligned to business requirements.
• Perform prepayment analytics and FWA tools to identify outlier behaviour.
• Refine tools to improve sensitivity and accuracy in detecting irregular claims behaviour.
• Review case reports for client and management intervention.
• Improve turnaround times of investigations focusing on claims risk management in healthcare.
• Ensure policies and SOPs related to claims risk management are followed.

Skills

People management

Risk management

Data analytics

Desktop investigations

Fraud awareness

Communication

Cross-functional collaboration

Audit

Education

B-degree in Accounting or Risk

Matric

Job description

Momentum Health is seeking an experienced risk management leader to guide a team focused on proactive risk identification in the prepayment domain, using structured forensic methodologies to mitigate fraud, waste, and abuse. The role oversees analysis of healthcare provider claims, identifies anomalies, and recommends mitigations to the client team.

The position requires strong people leadership, data analytics expertise, and collaboration across cross-functional teams, with hybrid office-based