Claims risk analyst

Role Purpose

To conduct desktop‑based forensic investigations into potential instances of fraud, waste, and abuse across Momentum Health administered schemes and to collect documentary evidence, engage with all relevant parties (e.g., service providers, members), draft letters and investigation reports, perform data analytics, and assist in the recovery of irregular paid claims.

Requirements Valid matric certificate. A relevant tertiary qualification such as Clinical/Healthcare related, Law, including Compliance, Business/Operations (e.g., auditing, accounting & operations). Medical Scheme knowledge would be an advantage. Three years of forensic experience. Responsibilities Conduct desktop forensic investigations to identify potential instances of fraud, waste or abuse across MH administered schemes. Report investigations by drafting investigation reports for management review and submitting to the relevant scheme. Engage with internal and external stakeholders to collect docu...