Specialist: Forensic Investigations - Centurion at PPS

Minimum Requirements

  Qualifications & Experience

• Grade 12
• Bachelor’s Degree in Forensic or equivalent
• Certified Fraud Examiner (CFE)
• 3+ years experience in a similar role
• 2+ Experience in working in the healthcare/insurance or banking environment 

Duties and Responsibilities

Key Responsibilities:

Forensics Investigations 

• Must assist in detecting and investigating fraud and suspected fraud and abuse within PPS, from initiation to finalisation of court cases. This would include the interviewing of witnesses and suspects as well as the examination of supporting evidence and documentation
• Assisting with the investigation of leads
• Must be able to perform investigations
• Ability to assess and interpret evidence, maintain the investigation's integrity, evaluate results and determine the cause, analyse the circumstance and make valid recommendations.
• Must be able to perform investigations so that the image of PPS is not detrimentally affected.
• Execute and actively participate in investigations
• Compiling case dockets for criminal prosecution ? Produce an investigative reporting

Stakeholder Management

• Responsible for claims investigations within the agreed time frame / SLA
• To provide the Claims department with properly investigated cases that will enable the assessors or requester to assess the claim and pay valid claims

Data & Reporting 

• Must be able to formulate data extracts and analysis to detect invalid claims and create data intelligence ability to ensure preventative management of claims investigations
• Preparing comprehensive audit and forensic reports, as may be required regarding action to be taken regarding the investigation.