Consultant: Forensic Investigations at PPS

Minimum Requirements    

Qualifications & Experience

• Bachelor’s Degree in Forensic or equivalent
• Certified Fraud Examiner (CFE) preferable
• Relevant post graduate degree will be advantageous.
• 5 years’ experience in similar role
• Experience in working in the insurance or banking environment.
• Strong communication skills (written & verbal)
• Strong networking and relationship building (Internal & external)
• Strong analytic and problem-solving skills
• Adaptability to different stakeholders, audiences, and environments
• Data analysis (conversant with pivot tables and other analysis tools)
• Ability to evaluate, identify and assess trends and patterns requiring further investigation.
• Ability to present case using the relevant presentation tools.
• Interpersonal skills to persuade and ensure compliance with established methods, models and concepts of investigation, to discussion among authorities involved in an investigation and reconcile differing interpretation of evidence.
• Ready to work in a challenging environment.
• Advanced forensic investigation capability and strategy implementation
• Identification of fraudulent activity / behaviour
• Formulation of investigation with other stakeholders (audit/HR/Insurance)
• Adapting and responding to change
• Commercial Acumen
• Persuading and Influencing
• Deciding and Initiating Action
• Collaboration

Duties and Responsibilities    

Key Responsibilities:

Forensics Investigations

• Must provide assistance in detecting and investigation of fraud and suspected fraud and abuse within PPS, from initiation to finalisation of court cases. This would include the interviewing of witnesses and suspects as well as the examination of supporting evidence and documentation.
• Assisting with the investigation of leads
• Must be able to perform specialised investigations.
• Ability to assess and interpret evidence, maintaining the integrity of the investigation, evaluating results, and determining cause, analyse the circumstance and make valid recommendations.
• Must be able to perform investigations in such a way that the image of PPS is not detrimentally affected.
• Execute and actively participate in complex investigations.
• Compiling case dockets for criminal prosecution
• Produce an investigative reporting.

Stakeholder Management

• Responsible for claims investigations within the agreed time frame / SLA
• To provide the Claims department with properly investigated cases that will enable the assessors or requester to assess the claim and pay valid claims.

Data & Reporting

• Must be able to formulate data extracts and analysis to detect invalid claims and create data intelligence ability to ensure preventative management of claims investigations.
• Do research on best practices and new trends in the industry.
• Conduct audits and fraud risk assessments where necessary, report findings or deviations and assist in implementing recommended controls.
• Preparing comprehensive audit and forensic reports, as may be required to make regarding action to be taken regarding the investigation.
• Prepare reports for different departments or upper management.