Lead Fraud Specialist

Job description

Job responsibilities

In this role, you are accountable for

1. Reactive bribery, fraud and corruption activities including monitoring progress of referrals on NHS Counter Fraud Authority (CFA) case management. Ensure all case management systems are fully utilised by the LFP team, ensuring that case details and management statistics are maintained to enable accurate reporting to auditable standards.

2. Ensuring proactive fraud, loss, bribery, and corruption activities are completed to ensure compliance with Gov13.

3. Ensuring information and intelligence received by the LFP Team from internal and external sources is handled appropriately to ensure that the content, where relevant is circulated to improve processes across the NHSBSA.

4. Establishing and maintaining effective liaison with stakeholders, including Department of Health & Social Care (DHSC) Anti-Fraud Unit (AFU), NHS England, Public Sector Fraud Authority (PSFA), NHSCFA, investigative bodies across both the public and private sectors, and professional and specialist bodies.

5. Supporting the Counter Fraud Manager in producing the NHSBSA LFP Annual Workplan. Assist in delivering activities and monitoring delivery of the workplan including providing updates to Senior Managers.

6. Supporting the Counter Fraud Manager in producing the NHSBSA Operational Control Framework, this includes identifying activities, monitoring progress and ensuring overall delivery of the Framework.

7. Create and deliver a range of presentations to staff and external audiences covering several areas such as fraud and bribery awareness including emerging risks and the progress of the LFP strategic objectives, framework and workplan.

8. Complete Fraud Risk Assessments (FRAs) as per the guidance to ensure risks are identified, controls monitored and measured to assess effectiveness and score the risk. Identify new controls and measure the benefits of these controls.

9. Complete due diligence for on services being onboard, ensuring fraud and loss prevention is embedded in processes and systems. Where prevention cannot be implemented then identify reporting and other detection controls so system weaknesses are identified at the earliest opportunity.

10. To lead on serious organised crime and complex criminal investigations ensuring they are investigated within operational and legislative guidelines undertaking the following activities:

Analyse possible avenues and methods of investigation to obtain evidence through various relevant means.

Use in-depth knowledge and experience of the processes and systems across the NHS to determine where relevant evidence can be found

Analyse and understand the financial, accounting, payment, and organisational factors in that part of the NHS relevant to the type and location of the fraud committed. Convert technical information into plain English, suitable for presentation at Court.

Establish contact with interview and take statements from relevant witnesses including expert 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, searches, and interviews with suspects.

Manage, co-ordinate and participate in operations involving searches and arrests with other agencies.

Actively assist police and other agencies in arrest and search procedures, providing expert professional advice where required, all in accordance with current legislation. Where evidence has been passed to the FS following such procedures, or otherwise obtained during an investigation, ensure that the integrity of the evidence is maintained in accordance with NHSCFA policy.

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

Maintain investigation files and evidence with due regard to the Criminal Procedures Investigation Act (CPIA) 1996, including management and disclosure of unused material in accordance with the act.

Construct prosecution files.

Provide advice to Corporate HR and managers on disciplinary, civil and criminal actions to be considered.

Manage and prioritise own caseload, adhering to non-negotiable deadlines imposed by courts and police.

Provide continuous support, advice, and guidance, and manage the expectations of, witnesses and victims including NHS staff, patients, and healthcare professionals, from the time of initial contact until after the conclusion of an investigation including any court process.

11. Prepare cases for criminal, civil and disciplinary consideration in all cases where evidence of fraud is established.

12. Attend criminal and civil courts, disciplinary hearings of NHS or other employers and professional and regulatory bodies, as and when required, 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.

13. Point of contact with NHSCFA for all aspects of investigative and intelligence sharing. This includes reviewing CLUE cases and distributing intelligence both internally and externally.

14. Ensure investigations are assessed and progressed in a timely manner by all members of the NHSBSA LFP Team, escalating any concerns to the Counter Fraud Manager.

15. Provide quarterly reporting on referrals to the Counter Fraud Manager.

16. Appropriate use, maintenance, and security of NHSBSA premises, assets, evidence, exhibits and equipment. Always ensure the integrity and continuity of evidence.

17. Responsible for managing staff within the LFP Team, this included completing regular one to ones, setting objectives and agreeing Personal Development Plans (PDPs).

18. Analyse financial, payment and other systems and regulations within the NHSBSA to identify system weaknesses that have allowed fraud to be perpetrated. Use expertise gained to comment on and propose strategies to impact on fraud in own area of work and across the wider NHS. Such strategies may include the redesign and implementation of policy, procedures, and legislation.

19. 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.

20. Maintain an up to date working knowledge of all relevant and appropriate legislation, standards, and procedures, including NHS structure, policy, detection, and investigative methods.

21. 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.

22. Prepare and present reports, submissions and other documents as required. Provide clear, complete, and accurate information for the purpose of press and publicity, Parliamentary Questions, internal and external senior management, professionals, and professional bodies

23. Promote and contribute to the development of policies, practices, and procedures for NHSBSA and more widely across the NHS.

24. Authorise expenses, overtime, and Purchase Orders to the value of £10,000.

25. Assist Counter Fraud Manager in Business Planning and monitoring the LFP Teams annual budget.

26. Work outside normal office hours when required, which will occasionally necessitate extended hours and possibly weekends. Travel and overnight absence from home when required, often at short notice. A recognition of the potential need to work away from base for longer periods of time subject to operational demands.

27. Participate in National Proactive Exercises: devising appropriate methodology, planning, and executing exercises.

28. To work in circumstances that are potentially hazardous and where there is potential to encounter hostile situations.

29. Deputise for the Counter Fraud Manager at meetings and manage the LFP Team in their absence.

Person Specification

Personal Qualities, Knowledge and Skills

Essential

• Ability to prioritise work for self and staff
• Able to work independently or as part of a team
• Ability to manage and analyse large amounts of data, draw sound conclusions and present findings in an easily understood format
• Demonstrate excellent written and oral communication skills and be able to communicate complex information persuasively, both orally and in writing, with people at all levels and across professions.
• IT literacy with knowledge of generic software packages.
• Demonstrable understanding and track record in promoting equal opportunities and diversity.
• Can demonstrate excellent communication and interpersonal skills.
• Considerable personal initiative with the ability to work independently, lead and work as part of a team.
• Demonstrable ability to tackle a number of diverse tasks and be able to prioritise and manage work accordingly whilst working to tight deadlines.

Desirable

• Ability to lead by example.
• Ability to manage adversity and challenging situations
• Self-motivated and have an energetic approach.

Experience

Essential

• Have 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 in a multi-agency environment.
• 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 designing and delivering workplans, action plans and frameworks.
• Experience of liaising closely with outside agencies within regulatory frameworks to combat fraud and corruption.
• Experience of managing a team with the ability to coordinate delegate and develop others effectively.
• Experience of collating and presenting detailed performance statistics for management.
• A proven ability to manage and motivate teams in a specialist environment especially where staff have some degree of autonomy from their normal place of work.
• Can demonstrate strong mentoring and coaching skills.
• Be able to demonstrate a comprehensive knowledge of investigative procedures with an up-to-date knowledge of systems and processes.
• Can demonstrate a clear analytical approach to both investigative work and the development and support of anti-fraud work in the NHS.

Desirable

• Experience of using IT as an investigative tool to counter fraud and corruption
• Has a full understanding of the judicial process.
• Practical experience of successfully investigating NHS fraud, bribery and corruption allegations

Qualifications

Essential

• Hold Accredited Counter Fraud Specialist (ACFS) or similar qualification, or be bale to demonstrate equivalent experience.
• Educated to degree level of equivalent in a relevant field or similar relevant experience.
• A current full driving licence

Desirable

• Post graduate level or equivalent, in a related field, 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.

Employer details

Employer name

NHS Business Services Authority

Address

Stella House

Goldcrest Way, Newburn Riverside

Newcastle upon Tyne

NE15 8NY

Employer's website

https://careers.nhsbsa.nhs.uk/ (Opens in a new tab)