Loss Recovery Service (LRS) Fraud Officer

Job description

Job responsibilities

In this role, you are accountable for:

1. To work with members of the Health Exemption Services carrying out appropriate fraud awareness work.
2. To investigate, within operational and legislative guidelines to the highest standards, patient fraud allegations identified within Health Exemption Services. Ensure that appropriate civil and/or criminal remedies are applied by the following means:

• Analyse possible avenues and methods of investigation to obtain evidence through various relevant means.
• Convert technical information into plain English, suitable for presentation at Court.
• Establish contact with, interview and take statements from relevant witnesses, displaying the knowledge and application of effective interviewing techniques to deal with hostile, uncooperative or reluctant witnesses.
• Prepare and present briefings to staff and police in relation to arrests and interviews with suspects.
• Where evidence has been obtained following such procedures ensuring that the integrity of the evidence is maintained in accordance with NHS Counter Fraud Authority (NHSCFSA) policy.
• Plan and conduct recorded interviews with suspects either at police stations or NHS premises in accordance with the Police and Criminal Evidence Act (1984).
• Construct prosecution files and submit to Crown Prosecution for their consideration.
• Maintain investigation files and evidence with due regard to the Criminal Procedures Investigation Act 1996, including management and disclosure of unused material in accordance with the act.
• Manage and prioritise own caseload, adhering to non-negotiable deadlines imposed by courts and police.

1. Attend criminal and civil courts, in the capacity of witness and/or case officer to give evidence competently, including in cross examination. Provide guidance, advice and instructions to Counsel and other legal professionals before and during criminal and civil proceedings.
2. Undertake duties with due regard to patient care and safety, particularly in terms of clinical circumstance, sensitivity and confidentiality, in accordance with Data Protection legislation and the NHS Confidentiality Code of Practice.
3. Carry out the responsibilities of the post with full and due regard to NHSBSA policies and procedures and negotiated agreements including those on Equal Opportunities and Health and Safety.
4. Maintain an up to date working knowledge of all relevant and appropriate legislation, standards and procedures, including NHS structure, policy, detection and investigative methods.
5. Maintain a good knowledge of available Information Technology and how it can best be used in the detection and investigation of fraud and to present data in a clear and appropriate format, often reflecting specific requirements.
6. Review processes and procedures within Health Exemption Services identifying system weaknesses where fraud and error could occur and make recommendations to reduce and/or eradicate the risk.
7. Undertake fraud and error measurement exercises in relation to the work of Health Exemption Services.
8. Prepare and present reports, submissions and other documents as required. Provide clear, complete and accurate information for the purpose of internal and external senior management and professionals.
9. Ability to manage and analyse large amounts of data, draw sound conclusions and present findings in an easily understood format to direct the Health Exemption Services on proactive initiatives.
10. Promote and contribute to the development of policies, practices and procedures within Health Exemption Services.
11. Work outside normal office hours when required, which will occasionally necessitate extended hours and possibly weekends. Frequent travel and overnight absence from home when required.
12. Appropriate use, maintenance and security of NHSBSA premises, assets, evidence, exhibits and equipment. Ensure the integrity and continuity of evidence at all times.
13. Responsible for personal development. Undertake relevant training as identified by line management.
14. Provide continuous support, advice and guidance, and manage the expectations of, witnesses and victims related to suspected patient fraud investigations, from the time of initial contact until after the conclusion of an investigation including any court process.
15. To work in circumstances where there is potential to encounter hostile situations.
16. Do you hold a clean, Full UK Driving License.
17. Practical experience of undertaking Interviews Under Caution at police stations or NHS locations

Plan and conduct recorded interviews under caution with suspects either at police stations or NHS premises in accordance with the Police and Criminal Evidence Act (1984).

An enhanced DBS check will be performed on the successful candidate and appointment will be conditional on this check not highlighting any issues.

In addition to the above accountabilities, as post holder you are expected to:

• Undertake additional duties and responsibilities in line with the overall purpose of your role and as agreed by your line manager.
• Demonstrate NHSBSA values and core capabilities in all aspects of your work.
• Foster an environment where your own and colleagues safety and well-being is promoted.
• Contribute to a culture which values diversity and inclusion.
• Comply with NHSBSA policies, procedures and protocols as they apply to your role.

Working relationships

Responsible to: Senior Loss and Fraud Officer

Key relationships and connections:

• Managers and staff within NHSBSA
• Crown Prosecution Service
• Police and other Law Enforcement and Investigatory Bodies
• Local Authorities
• Local Counter Fraud Specialists (LCFSs) and NHS bodies

Person Specification

Personal Qualities, Knowledge and Skills

• Knowledge of investigative procedures with an up-to-date knowledge of the legislation, systems and processes.
• Can demonstrate good analytical and problem-solving skills with the ability to question and validate unexpected results and to summarise information and data concisely and clearly in report formats.
• Sound understanding of the principles relating to the handling, processing and analysis of highly confidential information, including sensitive personally identifiable data.
• Good practical knowledge of Microsoft Word, Excel, Access Databases, e-mail, and ability to learn new software packages quickly.
• Demonstrate good written and oral communication skills and be able to communicate complex information, both orally and in writing.
• Ensure and maintain the highest standards of integrity and professionalism.
• Experience of working independently, lead and work as part of a team.
• Ability to work with minimum supervision to solve problems and make recommendations.
• Experience of tackling a number of diverse tasks and prioritising and managing work accordingly whilst working to tight deadlines.
• Be able to make an effective contribution within a team environment by providing advice, assistance and support to colleagues.

Experience

• A good awareness of NHS counter fraud arrangements.
• Practical experience of successfully investigating fraud and be able to demonstrate a proven track record of applying criminal and civil sanctions in relation to fraud offences.
• Experience of managing and analysing large amounts of data, drawing sound conclusions, and presenting findings in an easily understandable format.
• Experience of utilising IT packages to manage spreadsheets and /or databases effectively.
• Have an understanding of the practical application of all relevant legislation in relation to the investigation and prosecution of suspected fraud and corruption offences.
• Experience of liaising closely with outside agencies within regulatory frameworks.

• Knowledge of NHS structure and working practises.

Qualifications

• Educated to HND level in a relevant subject or equivalent level of qualification or equivalent previous proven experience.
• A current full driving licence.

• Hold an NHS Accredited Counter Fraud Specialist status or similar qualification, or be able to demonstrate equivalent experience.

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website.

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants.

Employer details

Employer name

NHS Business Services Authority

Address

Stella House,

Goldcrest Way, Newburn Riverside

Newcastle

NE15 8NY

https://www.nhsbsa.nhs.uk/what-we-do/work-us