Job Description
The Society wishes to invite applications from suitably qualified and experienced individuals to fill the position of FORENSIC MANAGER that has arisen in the Group’s Shared Services Division.
Duties and Responsibilities
Job Description
Manage the forensic function to ensure adequate mitigation of compliance, operational, technological, financial, and physical security risk.
Research, analyse, and identify emerging global industry trends that relate to Medical Aid Fraud, Waste and Abuse as well as Operational Fraud Risk.
Ensure reduction of fraud, waste, and abuse in line with Cimas Standard Operating Procedures.
Oversee and participate in the development of analytics models by the Forensics Officer to assess and identify anomalous trends relating to Medical Aid Claims and overall business operations.
Identify and review monthly claims analysis, data received from claims department and Internal Audit reports to manage anomalies.
Manage and follow through Anonymous Tip-Offs, concerns raised by members of staff or similar and checking response by the Forensic Officer.
Developing the necessary plan/s to ensure that the Forensic function meets set goals and objectives, engage departmental staff, identify and agree on key performance areas, key objectives/tasks, and action plans.
Qualifications and Experience
Candidate Requirements
Holder of a degree in Business Management, Finance, Audit, or Information Systems.
Certified Fraud Examiner, Chartered Accountant /Auditor an added advantage.
6-8 years’ service industry experience in Forensics/ Audit / Risk Management / Loss Control with minimum 2 years at management level.
Ability to lead, manage and develop staff with a sound business acumen.
Ability to analyse, present and solve complex problems to achieve the correct outcomes
