Local Counter Fraud Specialist

Job description

Job responsibilities

WORKING RELATIONSHIPS

The key working relationships are as follows:

Director of Finance, Finance Staff, Senior Managers, Departmental Managers, Internal Audit, People & Organisational Development, Trade Unions, Other NHS organisations, Local Authorities & other partners, External Audit, NHS Counter Fraud Authority, NHS Wales Counter Fraud Service.

GENERAL

The post holder will:

Manage the investigation of fraud cases for the Health Body for whom the post holder is the nominated Counter Fraud Specialist.

Produce investigation plans working with all relevant parties to ensure that the investigation is carried out in compliance with legal requirements and with due diligence. Plan the course of an investigation in conjunction with the relevant Managers and evaluate the appropriateness of arrests, the application for search warrants and their execution, the granting of bail and charging of alleged offenders with offences.

Produce case papers and reports in conjunction with the operational requirements of conducting criminal investigations, which often requires working to the tight deadlines inherent in the Criminal Justice System.

Complete fraud investigations in accordance with current legislation and NHS Counter Fraud Authority guidelines.

Conduct formal interviews with witnesses both internal and external to the NHS in accordance with the Police and Criminal Evidence Act 1984 and conduct interviews under caution with alleged offenders, on both a voluntary basis and when the alleged offender is under arrest, in accordance with the same act.

Prepare criminal cases for prosecution at both Magistrates and Crown Court and resume the responsibility of officer in charge.

Communicate with Solicitors and officers of the Court in pursuance of issues in conflict between the Health Body and other parties.

Act as witness at Magistrates Court, Crown Court, Civil Court and disciplinary hearings and support witnesses where required.

Complete the role and responsibilities of case disclosure officer in accordance with the Criminal Procedure and Investigations Act 1996 rules on disclosure and the Attorney Generals guidelines.

Where fraud is proven the post holder, in conjunction with the Head of Local Counter Fraud Service, will be responsible for seeking the application of a combination of appropriate sanctions. These may include criminal proceedings and/or the referral of cases for Disciplinary Hearings.

Be responsible for seeking recovery of monies lost on behalf of the Health Body through the Criminal or Civil Courts.

Promote awareness of the Betsi Cadwaladr University Health Board Counter Fraud, Bribery and Corruption policy.

Utilise appropriate experts to assist in the identification of potential local risk areas and to take action on information supplied by NHS staff or members of the public.

Identify potential fraud through the utilisation of intelligence and to develop the use of information resources to collate data.

Utilise IT to identify and combat fraud and utilise it in data analysis, data entry and the storage of data to create and format databases and spreadsheets in the furtherance of fraud investigation.

Report to senior management, auditors or contractors on the completion of fraud work (proactive or reactive) including highlighting system weaknesses and recommending improvements.

Undertake regular Awareness presentations across the Health Board to a variety of staff groups and audiences.

COMMUNICATION AND RELATIONSHIPS

To provide sensitive information requiring negotiating, persuasive skills. To discuss Counter Fraud queries with stakeholders..

To discuss counter fraud issues with stakeholders which may be contentious; provides advice on Counter Fraud and corporate issues to stakeholders, negotiating with NHS / external organisations in relation to NHS Service issues which may affect costs and amounts of money which required to be recovered due to NHS fraud which has occurred.

To advise stakeholders and potential witnesses, encouraging the correct course of action, developing and delivering fraud awareness presentations to various staff groups.

To attend Disciplinary Hearings and act as witnesses where necessary.

Regularly meet with the Assistant Director of Finance to agree work plans, review performance and provide briefings in relation to active cases.

KNOWLEDGE, TRAINING AND EXPERIENCE

To use specialist Counter Fraud knowledge across work procedures and practices, which are underpinned by theoretical knowledge and practical experience.

To use specialist knowledge across all NHS sectors, providing specialised advice the senior managers within the Health Board on matters relating to Counter Fraud issues, providing detailed advice and guidance, which has been acquired via Professional Qualifications and experience.

JUDGEMENT AND ANALYTICAL SKILLS

To exercise judgments involving facts or situations, which require the analysis, interpretation and comparison of a range of options. This will be in conjunction with the Head of Local Counter Fraud Service.

To analyse trends involving, using a wide range of data and assumptions which may indicate that NHS fraud has occurred.

To develop and advise on complex issues relating to NHS fraud matters and investigate and resolve complex issues relating to Counter Fraud.

When interrogating and analysing information systems to identify NHS fraud issues; to report thereafter to the Head of Local Counter Fraud Service.

Exercise knowledge across a range of managerial work procedures and practices underpinned by theoretical knowledge and practical experience.

To create reports from internal and external sources that allow evaluation of the Health Boards counter fraud service.

Assess, interpret and apply national guidance, legislation and local policy in order to ensure counter fraud strategies are compliant.

PLANNING AND ORGANISATION

Plans and manages the caseload assigned to the post holder.

Promptly investigate potential frauds under Police and Criminal Evidence Act -1984.

To plan and prioritise own work.

POLICY AND SERVICE DEVELOPMENT

To support the Head of Counter Fraud Service in the development of Counter Fraud, Bribery and Corruption policy of the Health Board.

To implement the Health Boards Counter Fraud, Bribery and Corruption policy and to propose policy and service changes across all sectors of the NHS in North Wales.

To propose changes and redesign of service in order to fraud proof the Health Boards systems and processes, which may impact on all sectors of the service which are managed by the Health Board.

FREEDOM TO ACT

Responsible for the day-to-day operational management of own workload, in line with the workplan as agreed by the Head of Counter Fraud Services.

The post holder will be expected to work independently guided by the Head of Counter Fraud Services and with broad occupational policies, but has to interpret these and is guided by Welsh Government and national counter fraud strategies.

The post holder will need to assimilate and summarise complex documents, compare facts and analyse situational data from a range of sources, develop options and assess risks and opportunities to the organisation.

To work to achieve agreed objectives and given freedom to do this in their own way of working, within broad professional policies; acts and provides advice under the guidance of the manager.

RECORDS MANAGEMENT

The post holder has the responsibility for timely and accurate record keeping and where appropriate in accordance with professional guidelines.

The post holder has the responsibility for the creation and maintenance of records in accordance with Health Board policy and the Data Protection Act.

Person Specification

Driving

Essential

• This post requires a full driving license and use of vehicle.

Criteria

Essential

• Postgraduate Diploma Level or equivalent experience.
• oKnowledge of relevant current law and the criminal/civil process.
• oGood working knowledge of database and spreadsheet IT packages including Word & Excel).
• oAccreditation as Local Counter Fraud Specialist or to be willing to work towards
• oExperience in the arena of criminal / internal including disciplinary investigations.
• oKnowledge of: -Procedures applicable to the successful management of criminal, civil investigations and disciplinary investigations, a proven track record in this area. -U.K. law as it relates to corruption, bribery and fraudulent activity -Preparation of case files for submission to solicitors and barristers. -Continual professional development.
• oExperience of dealing with highly complex and politically sensitive issues within a large organisation
• oExperience of completion of the Criminal Justice System MG forms.
• oAble to present relevant information in a concise and persuasive format
• oExcellent interpersonal skills demonstrating credibility, influence and political acumen; building and maintaining effective relationships across all grades and disciplines and within a wide variety of circumstances
• oThe ability to work as part of multi-disciplinary teams at operational level, both within and outside the Health Board.
• oThe ability to work on your own initiative, organising your own workload
• oAbility to achieve targets and objectives within a demanding and pressured environment against challenging deadlines.
• oKnowledge of legislation and procedures applicable to the successful management of criminal, civil and disciplinary investigations.
• oSound judgment, decision making, and organisational skills
• oAble to interpret legislation, national guidance as appropriate to the role.
• oSelf-motivated and committed to developing self and team members
• oAbility to use Spreadsheets (Excel), Word-processing (Microsoft Word), Databases and E-mail to a good level.
• oHighly developed organisational skills.
• oExcellent numeracy and analytical skills.
• oHighly developed verbal and communication skills with ability to relate to people at all levels.
• oExcellent report writing skills with an ability to distil information into key summaries.
• oAccurate record keeping skills.
• oProject management skills.
• oEnthusiastic, committed, proactive and innovative.
• oPolitically astute and high level of intuition.
• oAppetite for hard work and challenges.
• oShow resilience, stamina and reliability under sustained pressure, never losing sight of objectives.
• oHigh level of personal integrity.

Desirable

• oSpecialist knowledge of NHS legislation and NHS finance policies.
• oKnowledge and experience in a NHS finance environment.
• oData Analytics training or experience of the delivery of Data Analytics outcomes.
• oEvidence of further specialist training and experience.
• oA working knowledge of fraud investigation techniques and Health Service payment systems.
• oA knowledge of public sector financial systems.
• oNHS / public sector experience.
• Welsh Language Skills are desirable levels 1 to 5 in understanding, speaking, reading, and writing in Welsh

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).

Employer details

Employer name

Betsi Cadwaladr University Health Board

Address

Abergele/Denbigh/Wrexham

Abergele/Denbigh/Wrexham

Abergele/Denbigh/Wrexham

LL13 7TD

Employer's website

https://bcuhb.nhs.wales/train-work-live/ (Opens in a new tab)