Senior Manager: Internal Forensic Investigations – Medical Scheme - Pretoria
Develop policies and procedures, oversee and conduct investigations of fraud and financial abuse, occurring within the Scheme.
Responsible for preparing investigation reports and communicating such reports the relevant channels and recommending corrective action relating to internal control failures.
Interact with operational management, other investigators and law enforcement agencies in an effort to communicate investigative findings and to ensure that prompt and appropriate action is taken in response to reports of alleged fraud.
Identify/Manage and perform forensic investigations of high/sensitive nature, including lifestyle audits and vetting;
Appropriately plan and scope the investigations to ensure adequate investigatory focus;
Define the mandate/scope, draft investigation plan and submit for approval. Including the application of the applicable methodologies;
Execute investigations in a compliant manner ensuring adherence to the requirements of the applicable laws, regulations (associated within a forensic environment) and Scheme Policy and Procedures;
Appropriately control, secure and reference evidence acquired during forensic investigations;
Draft for review and present for Executive Approval Factual findings report and provide feedback to Senior Internal Stakeholders on investigation outcomes where necessary;
Present where required, evidence in Disciplinary enquiries, civil court and/or criminal court based on factual findings reports from investigations;
Adopt where appropriate, a litigation support role in respect of investigations in which the Scheme wishes to adopt legal proceedings;
Perform post fraud control reviews to identify the failings in the control environment which led to/facilitated the financial crime or misconduct;
Satisfy group audit Committee and Executive Committee reporting requirements in terms of investigatory progress and updates;
Maintain absolute confidentiality over investigatory information;
Perform compliance reviews in Divisions to ascertain whether the division complies with the Scheme’s Investigatory standards;
Perform Fraud awareness and fraud prevention/detection presentations to key stakeholders as and when required.
Degree in Forensic Investigations. Advanced degree is highly preferred;
Must be a Certified Fraud Examiner with the Association of Certified Fraud Examiners (ACFE) or equivalent.
At least 8 years of professional experience at a Group Level as a Senior Forensic Audit Investigator of which at least 5 years relate to the investigation of extensive, complex, detailed and confidential investigations;
Proven track record in the establishment / set-up of internal fraud / forensic investigation units;
Possess excellent written and oral communication skills, including the ability to present forensic findings in an objective and unbiased manner.
Strong, proficient analytical skills;
Excellent organisations and prioritisation skills with the ability to handle multiple tasks under stressful conditions;
Strong leadership and analytical skills, and ability to work independently and in a team environment;
Proficient in Excel, Word, PowerPoint;
Required to travel domestically as dictated by investigation assignments.
Have an understanding of the medical schemes industry.
Experience in the Internal Audit function leadership.