Loss Recovery Service (LRS) Fraud Officer

NHS Business Services Authority

Information:

This job is now closed

Job summary

NHS AfC: Band 5

12 month fixed contract/secondment

37.5 hours per week

If you have excellent communication, IT, analytical and problem-solving skills, with knowledge of investigating fraud and investigative procedures, the NHS Business Services Authority (NHSBSA) has an opportunity for you.

The NHSBSA plays an important role in tackling fraud and error across the wider NHS by reducing opportunities for fraud and error and improving the way that fraud and error risks are addressed.

We are currently recruitingfor two Loss and Fraud Officer to work within the NHSBSA Loss and Fraud Prevention Team on a 12-month fixed term contract.

The role involves educating customers on NHS Prescription Charges, potential exemptions and holding to account those who deliberately avoid paying NHS prescription charges.The role involves undertaking criminal investigations in accordance with the legislation and guidance from NHS Counter Fraud Authority.

The post is full time and involves travel and requires a full UK valid driving licence.Please state within your application under the 'Supporting Information' section if you do/do not hold this.

What do we offer?

  • 27 days leave (increasing with length of service) plus 8 bank holidays
  • Flexi time
  • Hybrid working model (working remotely and in the office when required)
  • Career development
  • Active wellbeing and inclusion networks
  • Excellent pension
  • NHS Car lease scheme
  • Access to a wide range of benefits and high street discounts

Main duties of the job

As a Loss and Fraud Officer, you will be responsible for:

  • Investigating patient fraud allegations identified by Health Exemption Services within operational and legislative guidelines.
  • Working with stakeholders within Health Exemption Services to carry out appropriate fraud and loss awareness work.
  • Presenting evidence to prove or disprove allegations, ensuring appropriate sanctions are considered.
  • Promoting and contributing to the development of policies, practices and procedures within the Health Exemption Verification Team.

The successful candidate will have practical experience of:

  • Communicating with potentially vulnerable people.
  • Using various questioning technics to extract information.
  • Analysing information and deciding next steps.
  • Managing own workload and an ability to prioritise.
  • GDPR and requesting information in accordance with legislation.

The post holder will either hold an Accredited Counter Fraud Specialist (ACFS) certificate or must successfully complete the ACFS training course within 6 months of commencing post.

The post is full time and employment in this post is subject to a satisfactory Disclosure from the Disclosure & Barring Service.

Applicants must be available to attend a face-to-face interview at Stella House .

About us

Here at the NHS Business Services Authority (NHSBSA), what we do matters.

We manage the NHS Pension scheme, process prescription payments and much more. Our services are used by NHS organisations, contractors and the public: we take pride in being part of something so meaningful, that touches millions of lives.

Just as we design our services around the needs of our customers, we place our people at the heart of our organisation. That's why when you join us, you'll be empowered and given the right support to help your career grow.

As one of the UK's Best Big Companies to work for, we're all connected to our values: Collaborative, Adventurous, Reliable and Energetic. We care about our people, our purpose, and your progress.

We strive to offer a fantastic colleague experience, where every voice is heard, and every colleague is supported and respected. Wellbeing, diversity and inclusion is at the centre of this, so when you join us, you can connect with our Lived Experience Networks who help us to bring our authentic selves to work.

We welcome applications from people of all backgrounds and circumstances. We are committed and proud to be a flexible employer and will endeavour to offer a working pattern that suits you wherever possible, whether that be hybrid working, flexible hours, job sharing and more.

We are people connected to care.

Date posted

19 June 2024

Pay scheme

Agenda for change

Band

Band 5

Salary

£28,407 to £34,581 a year per annum

Contract

Fixed term

Duration

12 months

Working pattern

Full-time

Reference number

914-BSA4663

Job locations

Stella House,

Goldcrest Way, Newburn Riverside

Newcastle

NE15 8NY


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

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

Essential

  • 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

Essential

  • 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.

Desirable

  • Knowledge of NHS structure and working practises.

Qualifications

Essential

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

Desirable

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

Personal Qualities, Knowledge and Skills

Essential

  • 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

Essential

  • 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.

Desirable

  • Knowledge of NHS structure and working practises.

Qualifications

Essential

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

Desirable

  • 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 (Opens in a new tab).

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 (Opens in a new tab).

Additional information

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 (Opens in a new tab).

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 (Opens in a new tab).

Employer details

Employer name

NHS Business Services Authority

Address

Stella House,

Goldcrest Way, Newburn Riverside

Newcastle

NE15 8NY


Employer's website

https://www.nhsbsa.nhs.uk/what-we-do/work-us (Opens in a new tab)


Employer details

Employer name

NHS Business Services Authority

Address

Stella House,

Goldcrest Way, Newburn Riverside

Newcastle

NE15 8NY


Employer's website

https://www.nhsbsa.nhs.uk/what-we-do/work-us (Opens in a new tab)


For questions about the job, contact:

Senior Loss & Fraud Officer

Aimee Moore

Aimee.moore@nhsbsa.nhs.uk

07557459898

Date posted

19 June 2024

Pay scheme

Agenda for change

Band

Band 5

Salary

£28,407 to £34,581 a year per annum

Contract

Fixed term

Duration

12 months

Working pattern

Full-time

Reference number

914-BSA4663

Job locations

Stella House,

Goldcrest Way, Newburn Riverside

Newcastle

NE15 8NY


Supporting documents

Privacy notice

NHS Business Services Authority's privacy notice (opens in a new tab)