Insurance Fraud Investigator

Placements24; Queenstown; Hybrid; NZD 70,000 - 110,000; Full time

Benefits offered by this job

Competitive salary

Performance-based incentives

Medical aid and retirement benefits

Training in fraud detection

Fully remote work environment

Job summary

Placements24 is seeking an Insurance Fraud Investigator for a fully remote role supporting operations locally and internationally. The role focuses on detecting, investigating, and preventing fraudulent insurance claims while maintaining data integrity and working from a home office.

The ideal candidate has at least 3 years of insurance fraud experience, strong analytical and interviewing skills, and a solid understanding of insurance policies and claims processes.

Qualifications

• Minimum 3 years of insurance fraud investigation experience.
• Ability to conduct thorough investigations and evidence gathering.
• Strong analytical, interviewing, and report-writing skills.
• Knowledge of insurance policies and claims processes.

Responsibilities

• Investigate suspicious insurance claims to identify potential fraud.
• Gather and analyze evidence, including documentation, statements, and digital records.
• Conduct interviews with claimants, witnesses, and other relevant parties.
• Prepare comprehensive and detailed investigation reports for management and legal teams.
• Collaborate with law enforcement agencies and regulatory bodies when necessary.
• Develop and implement strategies to prevent insurance fraud.
• Maintain accurate and confidential investigation case files.
• Utilize investigative tools and databases to uncover fraudulent patterns.
• Testify in legal proceedings as required.
• Stay updated on fraud trends, detection techniques, and relevant legislation.

Skills

Analytical thinking

Critical thinking

Problem solving

Interviewing

Report writing

Education

Tertiary qualification

Tools

Investigative databases

Job description

About the Role

Our client, a leading insurance provider dedicated to safeguarding against fraudulent activities, is seeking a sharp and resourceful Insurance Fraud Investigator to join their esteemed team. This role is critical in detecting, investigating, and preventing insurance fraud, thereby protecting the company's assets and maintaining the integrity of the insurance system. You will be responsible for examining claims, gathering evidence, conducting interviews, and preparing detailed reports on suspected fraudulent activities. The position offers a fully remote work arrangement, allowing you to leverage your investigative skills from the comfort of your home office, supporting operations in Queenstown, Eastern Cape, ZA and across the broader region. We are seeking individuals with a keen eye for detail, strong analytical abilities, and a commitment to upholding ethical standards in the pursuit of truth and justice within the insurance sector.

Key Responsibilities

• Investigate suspicious insurance claims to identify potential fraud.
• Gather and analyze evidence, including documentation, statements, and digital records.
• Conduct interviews with claimants, witnesses, and other relevant parties.
• Prepare comprehensive and detailed investigation reports for management and legal teams.
• Collaborate with law enforcement agencies and regulatory bodies when necessary.
• Develop and implement strategies to prevent insurance fraud.
• Maintain accurate and confidential investigation case files.
• Utilize investigative tools and databases to uncover fraudulent patterns.
• Testify in legal proceedings as required.
• Stay updated on fraud trends, detection techniques, and relevant legislation.

Requirements

• A relevant tertiary qualification or extensive experience in a related field (e.g., Law Enforcement, Criminology, Insurance).
• A minimum of 3 years of experience in insurance fraud investigation or a similar investigative role.
• Proven ability to conduct thorough investigations and gather evidence effectively.
• Excellent analytical, critical thinking, and problem-solving skills.
• Strong interviewing and interrogation techniques.
• Exceptional report writing and documentation skills.
• Proficiency in utilizing investigative databases and software.
• High level of integrity, discretion, and ethical conduct.
• Ability to work independently and manage caseloads efficiently in a remote setting.
• Knowledge of insurance policies and claims processes is essential.

Benefits

• Competitive annual salary of R.
• Performance-based incentives.
• Comprehensive medical aid and retirement benefits.
• Opportunities for specialized training in fraud detection and investigation.
• Fully remote work environment with flexibility.
• Supportive team and professional development resources.
• Contribution to a vital function in the insurance industry.