Fraud, Waste and Abuse Team Leader

About the role

We are seeking a Fraud, Waste and Abuse (FWA) Team Leader to protect the Scheme’s resources, members and healthcare providers. You will lead investigations, engage with stakeholders and ensure claims are managed with integrity.

Key responsibilities

• Lead and oversee FWA investigations into claims, members and providers, including duplicates, over‑payments and fraudulent activities.
• Manage reported fraud incidents from receipt through resolution, ensuring proper action, monitoring and follow‑up.
• Gather, assess and maintain evidence, preserving chain of custody and documentation.
• Compile comprehensive evidence packages and analysis reports detailing findings and recommendations.
• Represent the Scheme in engagements with members, providers and external investigators.
• Prepare accurate investigation reports and monthly management/committee summaries.
• Oversee cost‑recovery processes and ensure regulatory reporting requirements are met.
• Monitor departmental performance, meet service‑level targets and provide leadership to the FWA team.

Required profile

• Grade 12 with a degree in Forensic Science, Investigation or a related field.
• Advanced Certificate in Fraud Examination.
• Minimum 6 years of claims experience.
• At least 1 year of forensic investigation experience on medical‑aid claims.
• Minimum 2 years of leadership experience.