Introduction: To proactively prevent and detect suspicious and fraudulent activities in the funeral space preferably before claims are submitted, but also on reported claims, identify fraud trends and continuously develop process improvements and report on these trends to management. Description: THE JOB AT A GLANCE To proactively prevent and detect suspicious and fraudulent activities in the funeral space preferably before claims are submitted, but also on reported claims, identify fraud trends and continuously develop process improvements and report on these trends to management. WHAT WILL YOU DO? Investigations: Assist the organisation in its considerations and decision-making regarding investigations through written submissions and presentations Interpret policy and RMA decisions to stakeholders for effective communication Represent RMA at various forums and interact with other stakeholders Identify and report falsified claims to the legal department for recovery purposes Develop and refine models to proactively identify suspicious\potential fraudulent claims including but not limited to: Historical Claims Analysis Trend Analysis Background checks Identify fraud trends by analysing data and industry alerts Identify suspicious activity and work with appropriate teams to investigate and thwart the activity Provide statistical data on losses on a regular basis Develop processes and procedures to prevent or minimize claims fraud losses Work with the team to review data and reports that have potentially fraudulent transactions and/or suspicious activity Work with law enforcement on case investigations Ensure Service Level Agreement and turnaround times of external service providers and internal investigators are adhered to § Risk Management Contribute to the Due Diligence process before new funeral parlours are onboarded Identify key risk indicators and establish mitigating controls Ensure that expenditure is incurred within the limits of the sanctioned budget Ensure that new risks are identified, reported to risk for monitoring and that mitigating controls are implemented Reporting Compile monthly reports, as well as ad hoc reports, that meet regulatory reporting requirements requested by stakeholders (internal and external) Use appropriate templates and channels to report progress on a weekly and monthly basis Adhere to deadlines and timeously submit various periodical reports to Claims Management and internal committees Ensure accuracy and high quality of reports submitted to Claims Management and internal committees Proactively report on key insights and use these to identify opportunities for continuous improvement and innovation Produce weekly, monthly and quarterly complaints performance reports, update complaints KPIs and provide reports for senior management WHAT YOU'LL BRING TO THE TABLE? Certified Commercial Forensic Practioner (FP) SA (ICFP) member of the Association Certified Fraud Examiner (ACFE) NQF Level 7: Bachelors degree in Forensic Science or equivalent Diploma in Criminal Justice & Forensic Investigations / Auditing Proven track record with a minimum of 15 years' investigations experience At least 6 years investigations experience in the insurance industry Minimum 3 years in a managerial position in a fraud and forensic investigations role Experience in funeral insurance and funeral parlour business would be advantageous. Skills Knowledge of business policies, processes and procedures Knowledge of all related applications and processes relevant to the position of an Investigation Manager Computer literacy: Advanced MS Word, Excel and Outlook Good presentation skills and ability to interact with stakeholders at all levels Managerial and Financial Management skills WHAT WILL YOU GET IN RETURN? We offer great opportunities for personal and professional development in a stable company thats 130 years strong. The role comes with a competitive salary package and various benefits. Flexible work arrangements (combination of remote and in the office). Furthermore, you will be a part of a dedicated group of colleagues who value teamwork and collaboration. Turnaround time The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of managers. Kindly note that should you not receive a response within 21 days please consider your application unsuccessful. Closing date: 24 October 2024 Our Commitment to transformation: In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and targets, preference may be given, but is not limited, to candidates from under-represented designated groups. Requirements: Certified Commercial Forensic Practioner (FP) SA (ICFP) member of the Association Certified Fraud Examiner (ACFE) NQF Level 7: Bachelors degree in Forensic Science or equivalent Diploma in Criminal Justice & Forensic Investigations / Auditing Proven track record with a minimum of 15 years' investigations experience At least 6 years investigations experience in the insurance industry Minimum 3 years in a managerial position in a fraud and forensic investigations role Experience in funeral insurance and funeral parlour business would be advantageous.
