Forensic Administrator

Position

Purpose:

To provide comprehensive administrative and coordination support to the fraud, waste and abuse team by ensuring efficient case management, accurate record-keeping and timely processing of documentation related to fraud, waste and abuse within the managed care organisation.

Experience: Extensive Experience (2-3 years) in an administrative support role, healthcare/medical scheme environment (preferrable), data capturing.

Education: Degree or diploma in Office Management or Business Administration

Case administration and Coordination – Open, register and maintain forensic case files in line with SOPs and internal processes.

• Capture and update case information on relevant systems accurately and timeously
• Track case progress and follow up on outstanding information
• Ensure all case information is received, organised, complete, securely stored and audit-ready
• Maintain confidentiality requirements
• Prepare case packs, reports and supporting documents
• Maintain the workbasket with the agreed internal SLA
• Draft Follow-up correspondence where required
• Maintain logs of recoveries, savings and case outcomes
• Support the implementation and maintenance of fraud prevention workflows

Accuracy and completeness of data capturing and records.

• Adherence to turnaround time for case administration tasks
• Quality and organisation of case file
• Timely preparation of reports and documents
• Compliance with internal processes and audit requirements

• Strong organisational and administrative skills
• High attention to detail and accuracy
• Excellent record-keeping and document management ability
• Excellent written and verbal communication skills
• Business writing ability
• Ability to manage multiple tasks and meet deadlines
• Discretion and ability to handle confidential information
• Proficiency in Microsoft Office
• Excellent attention to detail and numerical accuracy.
• Efficient time management

Written and verbal interactions with providers, members and other stakeholders.

• Draft detailed investigation reports with findings, evidence, and recommendations.
• Maintain accurate, confidential case records in line with legal and policy requirements.
• Compile all the documents required to report the matter externally.
• Record all the information on the case management system/tracker.

• Work with medical aid administrators, actuaries, legal advisors, and third-party investigators.
• Represent the organization in engagements with the perpetrator, the client, regulators and industry bodies when necessary.

• Sound knowledge of medical aid industry laws and regulations.
• Knowledge of compliance regulations and reporting standards applicable to the industry.

Note:

Company reserves the right to close the advert before specified closing date.