Manager: Forensic Investigations at AfroCentric Group

Position Purpose

• To identify, investigate and anticipate fraudulent behaviours that impact the organisation to mitigate loss of income in all open, closed and corporate schemes. Project management and operational design; development and implementation of new forensic analytical platform and in-house case management system. Monitor adherence of new contract requirements and SLA’s.

Experience

• 5 - 6 years’ Medical Aid, criminal investigations (preferable fraud related and legal case management experience

Qualifications

• ACFE certification and/or relevant diploma/degree

What will you do

Continuous improvement

• Implement practical solutions that use the specialist and departmental systems and processes 
• Provide specialist input and recommendations to improve the efficiency, compliance and quality objectives related to the area of specialisation 
• Identify problems and develop and propose solutions to present to appropriate leader or stakeholders 
• Ensure day to day operational support required from area of specialisation is provided to enhance performance

Cost containment

• Support the identification, development and implementation of cost-effective processes to increase efficiency and reduce cost drivers related to area of specialisation 
• Continuously review cost / benefit and Return on Investment within area of specialisation

Drive customer-centricity

• Maintain a high level of impact on other departments to support improved delivery 
• Continually increase understanding of client and stakeholder needs, satisfaction and service delivery

Knowledge management

• Ensure that adequate knowledge regarding specialisation is shared as required and maintained within the research library 
• Provide advice and / or training as required 
• Maintain, develop and implement specialist knowledge within the day to day operations of the organisation

Maintain expertise level

• Be a member of related professional bodies 
• Ensure CPD (continual professional development) or similar accreditation requirements are met annually to ensure maintained specialist accreditation

Network key relationships

• Engage with and provide support to the established network of internal and external expert resources and partners

Specialist support to projects

• Provide Specialist expertise and ensure best practice related to specialisation is implemented in projects, when required 
• Conform to project management disciplines when participating in projects 
• Represent department or project on appropriate committees related to area of specialization

Specific deliverables:

• Drive customer centricity:
• Conduct accurate, detailed and evidence based investigations
• Develop detailed, business implementable recommendations on findings from investigations

Specialist support to projects:

• Ensure case notes and other investigation administration requirements are kept up to date and implemented at the required standards and within 

Service Level Agreement

• Present investigated cases to relevant organisations and bodies for appropriate action to be taken

Continuous improvement:

• Identify potential and actual process and system weaknesses that could lead to fraudulent activity and increase the organisational risk

Position Specific Outputs  

• Identify potential and actual process and system weaknesses that could lead to fraudulent activity and increase the organisational risk.
• Conduct accurate, detailed and evidence based investigations.
• Develop detailed, business implementable recommendations on findings from investigations.
• Ensure case notes and other investigation administration requirements are kept up to date and implemented at the required standards and within SLA.
• Present investigated cases to relevant organisations and bodies for appropriate action to be taken.
• Manage extraordinary discipline-based projects resulting from scheme requests.
• SLA monitoring and adherence to new contract requirements with Bonitas and Polmed.
• Assistance with formal Monthly Quality assurance process implemented to ensure adherence to processes implemented following the s59 inquiry and adherence to newly implemented SLAs for Bonitas.
• Management of NOC bench for receipt of internal and external fraud referrals.
• Ongoing quality assurance through review of exception reports.
• Team leader role to individuals in the forensic team on Admin level.
• Conduct system and process training for new staff as well as ongoing refresher training for existing staff including awareness of newly implemented processes.
• Representation with scheme meetings and preparation of reporting requirements.
• Project management and operational design as well as development and implementation of the new forensic analytical platform and the in-house case management system.

Attributes

• Ownership: Make critical decisions based on what's right for AfroCentric and Customers -Owning operational decisions and knowing oneself 
• Credibility: Lead with integrity and trust others as you would like to be trusted -Living the values and being transparent 
• Entrepreneurship: Take chances to continuously improve our Customer's experiences -Driving operational efficiencies 
• Influence: Engage with Customers and colleagues to advance the organisation's welfare -Making work happen 
• Collaboration: Build work-related network and share knowledge with colleagues -Building networks

Skill

• Relevant systems knowledge and application 
• Business Writing Skills 
• Communication Skills 
• Computer Technology Skills 
• Task Management 
• Adobe Creative Suite 
• Data modelling and evaluation 
• Knowledge and application of relevant legislation 
• Problem solving and decision making skills 
• Attention to Accuracy and Detail 
• Numerical Ability 
• Customer Focus 
• Knowledge and application of Forensic Investigations