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Fraud Analyst/ Pre-Payment Review

Ad ID
1270508
Posted at
Friday, 16:55
Details
Company Industry
Health care
Work Type
Full time
Job Level
Mid level
Minimum Qualification
Bachelor
Years Experience
3 years
Application Deadline
2019-02-25
Location
Nairobi CBD Nairobi
Description

Our client is a global health service company dedicated to helping people improve their health, well-being and sense of security. The company has almost 40,000 employees who service 85 million customer relationships throughout the world.

Their office in Kenya operates as a “liaison office”, providing administrative support to the parent company in Belgium, in relation with health insurance administration service.

YOUR JOB

  1. You thoroughly review triggered cases based on prepayment risk assessment and results of reimbursement firewall and take appropriate action.
  2. Via data mining techniques and in-depth analysis you uncover possible fraudulent activity by examining outliers.
  3. You assist in analyzing files which are passed on to the FIU due to suspected fraud.
  4. In so doing you respect the agreed protocols.
  5. Based on your initial analysis, you hand over all suspected cases to an Investigator for further investigation.
  6. You follow-up on files systematically and recall questions if answers are delayed.
  7. You follow-up on the individual workload (volume en TAT) and take appropriate measures, in consultation with your manager, if agreed objectives may not be met.
  8. You meticulously collect and document additional fraud detection triggers
  9. You take up a pro-active role in the optimizing of workflows of the FIU in order to attain set targets.
  10. You take initiative and show self confidence in your correspondence with third parties (providers, members, government instances).

YOUR PROFILE

  • You have a bachelor degree or equivalent through experience.
  • You have an excellent written and spoken command of English and French. Good command of additional languages would be an asset.
  • You have a very good knowledge of MS Office (Excel, Word).
  • You are analytical and have a critical mindset.
  • You are decisive.
  • You act with the highest integrity and respect for procedures.
  • You work efficiently and accurately.
  • You are strong in setting priorities.
  • You do mind working independently.
  • In team meetings, you participate actively and share best practices and learnings.

What's on offer…

  1. A challenging job in an international and diverse context
  2. ‘Happy You’: health and wellbeing initiatives, flexible hours, home working opportunities
  3. A dynamic international team, team leaders who train you patiently and a team manager who makes time for you
  4. An attractive salary and extra-legal benefits

You thoroughly review triggered cases based on prepayment risk assessment and results of reimbursement firewall and take appropriate action.

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