Unit Manager - Critical Care High Care

Mediclinic International; Pretoria; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A leading medical scheme in Pretoria seeks a Fraud, Waste and Abuse Manager to oversee fraud prevention and investigation efforts. Ideal candidates will have a relevant degree and significant experience in fraud management and the medical aid scheme industry. This role includes a competitive salary and a comprehensive benefits package including leave, insurance, and wellness programs.

Benefits

Free parking

Wi-Fi

Landline phone allowance

On-site gym

Subsidized meals

Free refreshments

Athletics Club

Pilates

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 own reliable vehicle.

Responsibilities

• Lead, manage, and enhance fraud, waste, and abuse prevention efforts.
• Develop strategies to prevent, detect, investigate, and mitigate fraudulent activities.
• Ensure compliance with regulatory requirements.

Skills

Reporting Skills

Management Skills

Education

Degree in Forensic Auditing, Forensic Accounting, Risk Management or related field

Job description

Unit Manager Critical Care High Care in Pretoria

Pretoria, Gauteng Medical Resources Group (Pty) Ltd

Fraud, Waste and Abuse Manager – Medical Scheme

Posted 11 days ago

Overview

The client: 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 join the team on a permanent basis. The successful candidate will 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

• Lead, manage, and enhance the organisation’s fraud, waste, and abuse prevention, detection, and investigation efforts across all healthcare-related claims and provider engagements.
• 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 drivers license and own reliable vehicle

Skills

• Reporting Skills
• Management Skills

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

This job posting may be updated. If this job is a match, apply to be considered for this opportunity.