Fraud, Waste & Abuse Investigator
Bestmed Medical Scheme · Pretoria
Job description
About the role
Bestmed Medical Scheme is looking for a detail‑oriented Fraud, Waste and Abuse Investigator to examine reported irregularities within the scheme. The role involves conducting thorough investigations, analysing evidence, and recommending appropriate actions to protect scheme resources.
Key responsibilities
- Investigate all fraud, waste and abuse matters reported to the scheme.
- Engage with service providers, healthcare providers and members on an ad‑hoc basis.
- Gather, assess and document relevant information and evidence.
- Prepare detailed investigation reports and provide well‑founded recommendations.
- Support operational and departmental targets related to fraud detection.
Required profile
- Grade 12 qualification.
- Diploma in Forensic Science, Investigation or a related field.
- Minimum 2 years experience in claims handling.
- At least 1 year experience in forensic investigation of medical‑aid claims.
- Advanced Certificate in Fraud Examination.
Required skills
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Published 1 month ago
Expires 4 days from now
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Bestmed Medical Scheme
Pretoria
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