5 Claims momentum Jobs and Work

Senior Forensic Investigator
Momentum Health —Bellville, Western Cape
Claims Risk Assessor
Momentum Health —Bellville, Western Cape
Preauthorization Administrator
Momentum Health —Centurion, Gauteng
2d
Dental Claims Administrator
Momentum Health —Centurion, Gauteng
3d
Head of Operations - France
AnyVan —Cape Town, Western Cape
- Full-time
- Remote
11d

More jobs to discover

Find similar jobs that you might be interested in.

Claims Risk Assessor
Momentum Health —Bellville, Western Cape
Fulfill data requests within 5 days of receipt. The Assessor will also provide critical support in data retrieval for internal and external stakeholders.
Claims Assessor
FirstRand —Johannesburg, Gauteng
Pay attention to details Manage personal development to increase own skills and competencies. Manage the claim from the claim registration to finalization.
6d

I want to receive the latest job alert for claims momentum

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

claims momentum jobs near

Administrator jobs in Centurion, Gauteng

Head Of Operations jobs in Cape Town, Western Cape

Production Administrator jobs in Cape Town, Western Cape

Office Administrator jobs in Booysens, Gauteng

Internal Sales Administrator jobs in Gauteng

Hr Administrator jobs in Johannesburg, Gauteng

It Administrator jobs in Pretoria, Gauteng

Office Administrator jobs in Paarl, Western Cape

Administrator jobs in Pretoria, Gauteng

Administrator jobs in Bellville, Western Cape

Investigator jobs in Midrand, Gauteng

Forensic Investigation jobs in Gauteng

Forensic Investigator jobs in Johannesburg, Gauteng 2049

Investigator jobs in Durban, Kwazulu Natal

Forensic Investigator jobs in Gauteng

Risk Assessor jobs in Johannesburg, Gauteng

Disaster Risk Management jobs in Cape Town, Western Cape

Graduate Risk Management jobs in Gauteng

Training Administrator jobs in Johannesburg, Gauteng

Financial Administrator jobs in Cape Town, Western Cape

Senior Forensic Investigator

Momentum Health -
Bellville, Western Cape

Apply Now

Job Details

Permanent

Full Job Description

Introduction

Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities, and businesses.

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

The Senior Forensic Investigator will lead and conduct in-depth investigations into complex cases of fraud, waste, and abuse within the medical aid administration industry. This role bridges the technical expertise of a forensic investigator with strategic oversight and leadership, providing expert guidance on investigations, collaborating with stakeholders, and contributing to the development of investigation processes and projects. The ideal candidate will have a strong background in medical aid schemes and forensic investigations, with the ability to drive high-quality results and support the professional development of team members.

Requirements

Qualifications

Matric / Grade 12 (essential).

Bachelor’s degree in Healthcare Management, Finance, Accounting, Forensics, or a related field (essential).

Experience

Minimum of 5 years of experience in healthcare fraud investigations, medical aid schemes administration, or related fields (essential).

Proven track record of managing and conducting complex investigations (essential).

Certification in fraud examination, healthcare compliance or a related field (desirable).

Knowledge

Proven experience in healthcare compliance and fraud investigation, with expertise in healthcare fraud, waste, and abuse.

Proven clinical expertise or knowledge.

Strong analytical and research skills, with experience using various analytical tools to conduct desktop investigations.

Excellent written and verbal communication skills.

Exceptional attention to detail.

Deep understanding of medical tariff codes, billing practices, and healthcare reimbursement methodologies.

Duties & Responsibilities

Process

Lead Complex Investigations.

Manage and conduct detailed desktop investigations into syndicate groups or complex cases of fraud, waste, and abuse within healthcare claims.

Analyse medical records, claims data, and billing statements to identify discrepancies, anomalies, and potentially fraudulent activities.

Use your advanced knowledge of medical aid schemes, policies, and procedures to assess claim validity and detect fraud.

Apply medical tariff codes and billing guidelines to ensure accuracy and appropriateness of billed services.

Client

Build and maintain relationships with clients and internal and external stakeholder.

Deliver on service level agreements applicable to clients and internal and external stakeholders to ensure that client expectations are effectively managed.

Participate in and contribute to a culture that builds rewarding relationships, facilitates feedback, and delivers exceptional client service.

Collaborate with internal teams, including data analysts, clinical advisors, and other forensic investigators, to gather and validate evidence

Conduct interviews with members, healthcare providers, and other relevant parties to collect and corroborate evidence.

Prepare comprehensive investigation reports to be presented to client summarising findings, conclusions, and recommendations for remedial actions.

Ensure reports are clear, well drafted, accurate, and actionable for both internal stakeholders and external regulatory bodies.

Testify as an expert witness in legal, regulatory, and disciplinary proceedings based on investigation findings.

Willingness to travel (locally) as needed for investigations, court appearances, and meetings. Travel is minimal to none however they may be a need if requested by client.

Office-based investigation role with virtual engagements with members and providers. Kindly note there is no field work involved and all analysis and investigations are performed strictly on a desktop level.

Contribute to the development and enhancement of investigation processes, methodologies, and best practices.

Provide expert guidance and support to existing investigators on complex cases and assist in their professional development.

People

The successful candidate should be able to address conflicts constructively, mediate disputes and foster a more collaborative and harmonious work environment.

Communicate clearly and assertively, while also being respectful and professional.

Lead by example through strong work ethic, integrity and respect towards all team members and all managers. Even though this role may not have direct managerial authority, strong leadership qualities are essential.

Finance

Identify solutions to enhance cost effectiveness and increase operational efficiency.

Competencies

Advanced analytical skills with the ability to interpret and analyse large volumes of data.

Strong report writing and presentation skills with the ability to communicate findings effectively to diverse audiences.

Excellent time management and organisational skills with the ability to handle multiple priorities effectively.

Ability to work in a fast paced and demand work environment.

Conducting investigative interviews.

Testify in criminal proceedings.

Testify and give evidence in civil, regulatory, society etc.

Apply Now

Refine Your Search

claims momentum jobs

Senior Forensic Investigator

Claims Risk Assessor

Preauthorization Administrator

Dental Claims Administrator

Head of Operations - France

More jobs to discover

I want to receive the latest job alert for claims momentum

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected