To continuously improve Special investigation Unit (SIU) service and contain expenses.
Ensure effective specialised investigation of Claims to minimise fraud.
Determining the merits of the claim - fraudulent versus legitimate.
Report findings of investigation in an effective and unbiased manner.
Conduct presentations on fraud awareness – Red Flags.
Ensure the timeous identification, if possible, of fraudulent claims, resulting in monetary savings for the company.
Ensure data is quality controlled.
Effectively communicate and give feedback to clients, staff, and call center as required.
Analyse query and complaints trends and suggest solutions.
Prepare periodic reports and presentations on project progress, issues and progress against timeline reports/updates.Service delivery to ensure customer satisfaction
Maintain service, quality and desired outputs within a specific functional process through ensuring compliance to tactical policies, procedures and standards.
Resolve escalated customer queries and complaints and provide feedback to customers on matters resolved.
Develop work routines in line with operational plans / schedules in order to manage achievement of service delivery goals
Measure and monitor service delivery compliance of team.
Share knowledge on, and participate in the creation of new standards, control systems and procedures to maintain service delivery.
Share and transfer product, process and systems knowledge to colleagues.
Collaborate and work with the Claims team to ensure required service levels are delivered.
Actively participate in the Claims team to ensure functional balanced scorecard objectives are achieved.
Actively share information with other team members regarding successes, issues, trends and ideas.
Actively participate in own professional development and career path.
Track and resolve operational and performance variations
Develop and encourage strong team work
Identify potential inter-departmental problems and escalate them to higher levels
Engage regularly in team or group problem-solving
Manage areas of critical compliance and actively manage non-conformance
Actively manage non-performance
Ensure the work environment enables employees to “live” the organisation culture and values. Ensure effective cost control and governance compliance
Ensure adherence to financial and corporate policies and procedures, and reduce wastage related to area of accountability.
Take accountability for the management of business related risks within own area.
Operate within agreed mandates as documented in the business rules. Continuous improvement to ensure effective service
Ensure adherence to organisational policies, practices and procedures.
Identify and recommend areas / ways to improve processes.
Job Requirements
Matric
Minimum 3 years’ experience in a related field
Extensive knowledge of Criminal Procedure Act (51 of 1977) i.e. gathering and chain of evidence in preparation of matters for court procedures
Extensive knowledge of SA Criminal Law i.e. elements and definitions of applicable crimes
Interpretation of policy wordings, conditions and application (preferable)
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