Pretoria: Fraud, Waste and Abuse Manager – Medical Scheme posted by Medical Resources Group (Pty) Ltd

About Our Client: Our client is a leading medical scheme based in Pretoria, dedicated to providing comprehensive healthcare benefits to its members. They are committed to innovation, quality service, and the well-being of their clients.

The role:

Our client is seeking a Fraud, Waste and Abuse Manager to join their team on a permanent basis. The successful candidate will be responsible to lead, manage, and enhance the organisations fraud, waste, and abuse prevention, detection, and investigation efforts across all healthcare-related claims and provider engagements.

Functions:

• To lead, manage, and enhance the organisations fraud, waste, and abuse prevention, detection, and investigation efforts across all healthcare-related claims and provider engagements.
• Responsible for developing, implementing, and overseeing strategies to prevent, detect, investigate, and mitigate fraudulent, wasteful, and abusive activities for the Scheme.
• The role ensures compliance with regulatory requirements, protects the Schemes financial integrity, and safeguards member and provider trust.

Skills:

• Excellent computer skills
• Reporting Skills
• Management Skills.

Requirements:

• Grade 12
• Degree in Forensic Auditing, Forensic Accounting, Risk Management or related field.
• 5 – 7 years of experience in fraud management/investigations
• 5 years of experience managing large scale investigations
• 3 years experience in a Medical Aid Scheme Industry
• 3 years claims assessing experience
• Valid drivers license and own reliable vehicle

Remuneration:

• Competitive salary commensurate with experience.
• Exceptional benefits program including 23 days of annual leave, 8-hour workday with a 30min break, life cover, disability benefits, funeral cover, pension fund, medical aid, and more.
• Office perks: free parking, Wi-Fi, landline phone allowance, on-site gym, subsidized meals, free refreshments, Athletics Club, Pilates, and wellness programs.
• Dynamic team interactions, recognition programs, and incentives.

Join Our Client: Be part of a team that values innovation, quality service, and the well-being of its members. Apply today to contribute to a leading medical scheme’s success and make a difference in the lives of many.

Application Process: Interested candidates should submit their CV and cover letter, highlighting their experience related to the job functions and skills listed above to *****@*****.co.za with REF FWA Manager. If you do not hear back from us within 2 weeks of applying, please consider your application unsuccessful.