Manager: Prepayment Analytics

Manager: Prepayment Analytics (Forensic Investigator) (Data Analyst)Our Client, Momentum Health Solutions, who has been voted top employer of the year twice in a row, is looking for a Specialist/Manager supporting a FWA Health Investigative/forensic team. The successful candidate will be based at the Bellville office (Parc du Cap) and will be required to work from the office at least twice a week (Hybrid model).Duties and Responsibilities:Perform prepayment analytics using IBM’s suite of real time fraud detection analytical tools to identify outlier behaviour and potential FWARefine these prepayment tools to improve the sensitivity and accuracy thereof in detecting irregular claims behaviourReview case reports or summaries prepared by direct reports to be presented to client and management for timeous intervention in mitigating future financial losses to client because of the detected fraudManage & support a team of FWA forensic InvestigatorsMentor and provide guidance to the Investigator team to focus the investigations conducted and to improve their skill set and report writingAudit the information received from providers and draw appropriate conclusions on the validity thereof and the extent to which the findings have been provenQuantify the extent of losses incurred and contribute to the compilation of a report as requiredRecommend necessary action to be taken, which could include closing a case and/or presenting findings to the client forum for decisioning or punitive sanctions where requiredAttend client meetings or forums as well as healthcare service provider engagements as necessary, to address the risks at hand and to affect the necessary future action to be takenInvestigate client queries within the agreed service level and ensure that client receives timeous feedbackManage documentation, records, investigation notes and other evidence, ensuring accurate and accessible record keepingParticipate in legal processes where required and testify to investigation findings if necessaryLiaise with various internal and external stakeholders to build and maintain relationshipsKeep abreast of relevant legislation, regulation, and policies within the Healthcare industryContribute to the development of fraud prevention policies, strategies, plans and other related documentsParticipate and contribute to a culture of performance excellenceProven experience managing a high-performance team / leading a team of 5 staffMinimum Requirements:Education:Relevant B-degree in Accounting, Quantitative analysis, Risk Management, Auditing, Forensic Investigations, Criminal, or related fieldMatric or equivalent qualificationCertificate in Money Laundering Control, ACAMS Certificate or Certified Fraud Examiner (ACFE), or equivalent (Desirable) Membership to a Professional body (Desirable) Knowledge:Knowledge of Fraud, Waste and Abuse regulatory environmentKnowledge of Insurance, Health and Financial Services IndustryKnowledge of