Fraud Waste & Abuse Inspector

SUMMARY:
FWA Inspector is required for a leading medical scheme in Tshwane to review and investigate any details of claims (related information) for any fraud waste and abuse claims to enable the scheme to recoup funds, reduce fraud, waste and abuse.

POSITION INFO:

Work experience

At least 2 - 3 year''s experience in processing claims . 1 Year experience in forensic/investigative claims assessing or dealing with fraud, waste and abuse claims in a medical scheme .

Requirements:

Knowledge related to the industry will be a requirement. Experience in claims assessing and the understanding thereof. An understanding of claims processing system (expected within 3 months). Understanding and knowledge of Medical Scheme Rules/compliancy. Proven working experience, persistence to obtain case information not readily available and ability to work independently with minimum supervision. Extraction of reports, identification of "codes" to investigate/identify fraud, waste and abuse claims  and submission of claim reports with updates on traction. Detect and safeguard the financial integrity of the scheme and minimize losses pertaining to fraud, waste and abuse claims.

Educational Requirements:

Grade 12. Computer Literacy * Intermediate. Typing skills * Accuracy. Post matric qualification- Diploma in healthcare administration or related field desirable. Certificate in Business Administration (Advantageous)