Loss and Fraud Officer

Detailed job description and main responsibilities

Detailed job description

In this role, you are accountable for
1.    Capturing the risks identified during the Fraud Risk Assessment (FRA) process which requires you to:
•    Research the relevant service area to gain an understanding of the work undertaken prior to any meetings and discuss any relevant findings with the Fraud Specialist prior to the meetings.
•    Review processes and procedures within the Service Area to highlight system weaknesses that have allowed or could allow fraud and loss to be perpetrated.Capture the risks that are discussed in FRA meetings with the Services, ensuring you document the risks clearly and concisely to meet the criteria of the Cabinet Office FRA.
•    Capture and articulate all relevant controls for each risk, explaining what they do and what they don’t do, including the limitations of the controls.
•    Articulate the residual risk which describes how the fraud / loss can still occur despite the controls in place.
•    Share the risks with the Fraud Specialist who are responsible for leading the FRA meetings, scoring the risks and sign off the FRA prior to it being shared with the relevant service area for comment.

2.    The Consolidated Data Returns (CDR) submission to the Cabinet Office which requires you to:
•    Collate data from all relevant service areas to create the quarterly submission.
•    Communicate relevant deadline dates to the service areas and send reminders so we achieve the deadline date.
•    Prepare and submit the quarterly CDR to NHS Counter Fraud Authority (NHSCFA) who will return it to the Cabinet Office.
•    Update the section of the NHSBSA Loss & Fraud Workplan with the CDR figures for the quarter.

3.    Produce Training Materials on a variety of fraud, bribery and loss topics - this can include money laundering, bribery, witness statements and false documents. This will require you to:
•    Research topics
•    Liaise with relevant external agencies such as Home Office, Crown Prosecution Service, NHSCFA for examples
•    Prepare training materials
•    Assist the LFP Manager and / or Fraud Specialist in delivering the sessions by arranging the sessions, sending out invites, circulating materials, circulating feedback forms and collating responses then updating the spreadsheet.

4.    Deliver fraud, bribery, corruption and loss awareness sessions internally and externally. You will be responsible for:
•    Creating awareness material, tailoring to suit the audience and delivery style
•    Setting up awareness sessions with the services outlined in the NHSBSA Loss & Fraud Workplan or as directed by the LFP Manager and Fraud Specialists
•    Delivering awareness sessions
•    Issuing feedback forms and in the absence of the Fraud Assistant, update the spreadsheet with all feedback then amend the material depending on feedback.

5.    Review and monitor the content of the LFP Team eLearning modules to ensure they are up to date and are being completed across the business.

6.    Monitoring and maintaining the fraud and bribery risks contained in all Service Area Risk Registers (SARR) including the NHSBSA LFP Team SARR.
7.    Undertake investigations where you will:
•    Record referrals in accordance with the documented processes.
•    Analyse possible avenues and methods of investigation to obtain evidence through various relevant means.
•    Use 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, displaying the knowledge and application of effective interviewing techniques to deal with hostile, uncooperative or reluctant witnesses.
•    Where evidence has been obtained following such procedures ensuring that the integrity of the evidence is maintained in accordance with NHS Counter Fraud Authority (NHS CFA) 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). This will involve booking meeting rooms at police stations, liaising with solicitors, creating investigation plans, preparing disclosure, undertaking assessment to address if appropriate adult is needed / subject is fit to be interviewed and leading the interview.
•    Constructing prosecution files and submit to Crown Prosecution Service (CPS) 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.

8.    Monitor the progress of the information and intelligence being received into the LFP ensuring the Fraud Assistants are processing initial referrals in accordance with the NHS Counter Fraud Manual, Guidance from NHSCFA, CPIA, NHSBSA Referral for Investigation Process and in accordance with GDPR. You will monitor and review the referrals on CLUE to ensure what is detailed on the LAN is recorded on CLUE. Support the Fraud Assistant on progressing rejected referrals, referrals received in error and such like.

9.    Prepare and present reports, submissions and other documents as required, this will include:
•    Quarterly reporting to the Service areas on referrals received
•    Responding to requests for information such as Freedom of Information (FOI) where you will collate the information and prepare a submission for Fraud Specialist or LFP Manager approval prior to sending to requester.

10.    Manage and analyse large amounts of data, draw sound conclusions and present findings in an easily understandable way.

11.    Design spreadsheets to capture information and reporting, this will include working with colleagues in Management Information Services and Data & Insight to produce dashboard and reports in Shiney to highlight the benefits of the proactive and reactive work being undertaken.

12.    Provide clear, complete and accurate information for internal and external senior management and professionals.

13.    Promote and contribute to the development of policies, practices and procedures across the NHSBSA.

14.    To support Fraud Specialists and LFP Manager at Due Diligence meetings by taking notes, documenting risks highlighted during initial meeting and complete due diligence spreadsheet where required then submit.

15.    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.

16.    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.

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

18.    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.

19.    Work outside normal office hours when required, which will occasionally necessitate extended hours and possibly weekends. Travel and overnight absence from home when required.

20.    Appropriate use, maintenance and security of NHSBSA premises, assets, evidence, exhibits and equipment. Ensure the integrity and continuity of evidence at all times.

21.    Responsible for personal development. Undertake relevant training as identified with your line manager.

22.    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.

23.    To work in circumstances where there is potential to encounter hostile situations.

In addition to the above accountabilities, as post holder you are expected to
1.    Undertake additional duties and responsibilities in line with the purpose of your role and as agreed by your line manager.
2.    Demonstrate NHSBSA values and core capabilities in all aspects of your work.
3.    Encourage an environment where your own and colleagues’ safety and well-being is promoted.
4.    Contribute to a culture which values diversity and inclusion.
5.    Follow NHSBSA policies, procedures, and protocols as they apply to your role.

Working relationships

Responsible to: Senior Loss and Fraud Officer

Responsible for: n/a

Key relationships and connections
1.    Managers and staff within NHS BSA
2.    Crown Prosecution Service
3.    Cabinet Office
4.    DHSC
5.    Police and other Law Enforcement and Investigatory Bodies
6.    Local Counter Fraud Specialists (LCFSs)