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- Researches, analyzes and identifies emerging Global industry trends that relate to Fraud, Waste and Abuse.
- Identifies the human, equipment, and financial resources the department will require to perform its mandate.
- Develops the department’s Annual Operating Plan ensure monitors its implementation.
- Analyses and identifies during each financial year the following: o Group-wide fraud, waste, and abuse e.g. (Inappropriate interpretation of claiming rules, inappropriate use of tariffs)
- Incident and Tip-Off Anonymous reports, risk registers, level of recoveries and similar
- Participates in the development of policies and procedures on proactive fraud monitoring, waste, and abuse of Cimas technological and financial resources.
- Oversees and participates in the development of analytics models to assess and identify anomalous trends relating to business operations i.e. Inventory Management, Financial Transactions and Medical Aid claims.
- Oversees the process of Fraud, Waste and Abuse investigations, ensuring reporting is in line with regulatory/statutory requirements, and confirms recoveries if any, and approves reports
- Oversees and follows through on Anonymous Tip-Offs, concerns reported.
- Checks the update and maintenance of the Vulnerability Management Programme, including establishing mechanisms to identify new vulnerabilities and changes in the threat landscape.
- Develops internal and external stakeholder training and awareness programs on fraud, waste and abuse prevention and operational fraud prevention.
- Represents Cimas in internal disciplinary hearings and civil or criminal court proceedings relating to findings of investigations
- Relevant Business Management / Finance/ Audit/Information Systems degree
- 6-8 years’ experience Forensics/ Audit / Risk Management
- Registered with a professional body in the relevant field, including but not limited to Certified Fraud Examiner, Chartered Accountant/ Audit related profession.
- Proficiency in the use of Microsoft Office Suite.
- Experience in conducting, leading, and supervising investigations.
- Must have interrogation skills and be aware of the legal restrictions of interrogating individuals.