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  • Posted: Aug 25, 2021
    Deadline: Not specified
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  • Imagine a world where people live healthier, more enhanced and protected lives… A world in which each organisation is a powerful influencer and responsible corporate citizen, committed to being a force for social good. As a leading innovator in healthcare, wellness, insurance, investments, financial and life planning, Discovery works ceaselessly to...
    Read more about this company

     

    Forensic Investigator

    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

    Method of Application

    Interested and qualified? Go to Discovery Limited on careers.discovery.co.za to apply

    Note: Never pay for any training, certificate, assessment, or testing to the recruiter.

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