First Mutual Health Company
DUE: 04 AUG 2024
Applications are invited from suitably qualified and experienced persons to fill the below vacancy that have arisen within First Mutual Health Company.
The Job
Reporting to the Managed Care Supervisor, the successful candidate will be responsible for the following:
- Investigating and monitoring provider and member claiming patterns.
- Monitoring tariffs misuse, abuse and/or fraudulent activities and making recommendations based on the findings
- Investigating and monitoring possible fraud cases highlighted during the AHFoZ risk management committee
- Communicating with internal stakeholders on outcomes and investigation findings
- Assessing threats to the business capital and earnings from system configuration and robustness, fraud (internal and external), waste, and abuse
- Providing advice through recommendations on possible resolution to issues that arise
- Representing First Mutual civil or criminal court proceedings relating to findings of investigations
- Reviewing the adequacy of existing internal controls, and forensic management framework through continuous identification
- Coordinating activities in developing, implementing and sustaining an acceptable forensic investigation and monitoring environment and culture
- Engaging providers and members on fraudulent cases identified
- Following up all recoveries from stakeholders through constant reminders.
REQUIREMENTS
The ideal candidate must possess the following:
- Diploma or Degree in Health Care / Mathematics / Statistics
- 3 years working experience in a similar role.
- Problem solving skills
- Good communication skills
- Report Writing skills
TO APPLY
Candidates meeting the above criteria should forward their Curriculum Vitaes (CVs) and application letters to Group Human Resources via the following email address careers@firstmutual.co.zw
Applications should be sent by and not later than 04 August 2024.
N.B Clearly label the position you are applying for in the subject line.
First Mutual Holdings Limited is an equal opportunity employer which does not discriminate on the basis of race, colour, religion, sex, gender, national origin, age and disability status. The Group encourages applications from competent people of different demographic groupings. We foster a work environment that is inclusive and diverse where every idea and perspective is valued.