Fraud Risk Manager at FEM

Job Description

• Applications are invited for a Fraud Risk Manager position in Head Office. Reporting to the Chief Risk Officer, the primary purpose of this position is to develop, implement, and maintain all aspects of the fraud risk management framework within the broader enterprise-wide risk management framework. This includes building out the fraud risk management framework to ensure effective fraud risk management practices are in place across the organization that meet internal and regulatory requirements.
• The Fraud Risk Manager facilitates the identification and assessment of fraud-related risks across the business, works with management to identify risk mitigation plans, and monitors the effectiveness thereof in collaboration with the Operational Risk Manager. The Fraud Risk Manager facilitates the investigations process in collaboration with external fraud investigators.
• The Fraud Risk Manager co-ordinates, validates, monitors, and reports on all facets of fraud risk across the business, and makes recommendations on key fraud risk and control issues. The Fraud Risk Manager develops and implements strategies, systems and processes that are geared towards enhancing the management and oversight of fraud across the business through preventative, detective, and corrective controls.
• The Fraud Risk Manager provides second-line oversight over all aspects of fraud risk management across the business.
• The successful candidate is responsible for the implementation of the fraud management strategies, policies, and standards across the company.

Responsibilities:

Fraud Management

• Develops and implements the fraud strategy for the business including the definition of prevention and detection strategies.
• Leads the development of the fraud operating model across the business.
• Works with key internal and external stakeholders to operationalize the fraud strategy across the business.
• Manages all fraud-related policies and ensures policies meet or exceed all regulatory requirements and align with industry standards and practices and monitors compliance with fraud policies and procedures on an ongoing basis.
• Oversees the design, development, and management of systems to combat systemic fraud.
• Works with key internal and external stakeholders to assess the current control environment and propose strategies that are aligned with the objectives and risk appetite of the business.
• Drives the development of capabilities to monitor, analyse, and report key fraud-related insights to the business.
• Owns key third-party fraud relationships and source third party service providers.

Fraud Risk Management

• Defines fraud risk appetite and ensures alignment with business objectives.
• Ensures that all fraud-related risks are appropriately identified, assessed, managed, monitored, and reported.
• Develops robust and cost-effective fraud prevention and investigation activities to reduce the threats of internal and external fraud and ensures the implementation of relevant controls.
• Monitors the adequacy and effectiveness of the control environment as it pertains to fraud.
• Drives the adoption of systems and tools for fraud risk management and mature the use of technology to optimize fraud risk management capabilities
• Provides regular assurance to internal and external stakeholders.
• Reports and identifies any new trends relating to fraud risk and works with Operational Risk to determine the fraud risk landscape.
• Champions fraud awareness across the business and provides training to key stakeholders on fraud-related matters.

Investigations

• Conducts preliminary investigations on all cases received where there is suspicion of fraud and corruption to determine whether further investigation is warranted.
• Ensures appropriate and timely initial responses to fraud incidents or events.
• Coordinates fraud investigation activities, collaborates with external fraud investigators as necessary, and reports results of investigations to the CRO and other senior leaders in the business.
• Ensures all stakeholders are timeously informed of potential fraud.
• Analyzes any fraud-related findings from Claims Quality Assurance Specialist
• Co-ordinates with relevant authorities (e.g., South African Police services, Department of Home affairs, Department of Labour, BHF and ICB) Conducts regular audits of medical service providers and invoices.
   

Education and Experience Requirements

Minimum:

• Degree in Risk Management, Auditing, Forensic Investigation, or a related field
• Certified Fraud Examine (CFE) qualification.
• ACFE membership
• 8 years’ experience in fraud risk management
• Functional experience in the field of fraud or financial crime risk management
• Knowledge of data analytics tools for fraud detection and management would be an advantage.
   

Skills and Abilities

• Strong oral and written communication skills.
• Ability to communicate effectively with stakeholders at all levels.
• Ability to deliver results on a timely basis.
• Advanced analytical and problem-solving skills.
• Ability to identify and resolve technical, operational, and organizational issues.