Forensic Investigator - Sandton at Discovery Limited

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