Forensic Investigator at Discovery Limited

Key Purpose

This role falls within the Discovery Group Forensics department and reports to the General and Divisional Manager.  The successful candidate will be required to investigate all issues pertaining to healthcare fraud

Areas of responsibility may include but not limited to:

• Investigating allegations of healthcare fraud against Discovery

• Doing administrative tasks

• Following up on leads regarding allegations of healthcare fraud

• Conducting investigations into all aspects pertaining to healthcare fraud

• Instituting measures to prevent fraud

• Confronting perpetrator/s and taking necessary action where applicable

• Analyzing data to identify possible fraudulent trends i.e. coding, drugs analysis etc.

• Collecting, evaluating and handling of evidence

• Ability to identify fraudulent/suspicious claims profiles

Personal attributes and skills – Discovery Person

• Plans activities and projects well in advance and takes account of possible changing circumstances

• Easily establishes good relationships with customers and staff

• Ability to communicate clearly and concisely

• Focuses on customer needs and satisfaction

• Probes for further information or greater understanding of a problem

• Assertive

• Takes initiative and works under own direction

• Keeps emotions under control during difficult situations

• Diplomatic

• Knowledge of Medical Aid industry

• Good understanding of healthcare legislation

Education and Experience

Minimum:

• 2 years’ experience in the healthcare environment

• Clinical qualification

• Good understanding of claims and NHRPL coding

• Understanding of healthcare investigations