Claims Investigator - Fraud Detection

Placements24; Willows (CA); Hybrid; USD 25,000 - 36,000; Full time

Benefits offered by this job

Medical aid

Provident fund

Hybrid work model

Bonuses

Job summary

Placements24 is seeking a meticulous Claims Investigator to join a fraud detection unit in Welkom. The role involves investigating potentially fraudulent insurance claims, gathering evidence, interviewing witnesses, and preparing detailed reports.

Hybrid work arrangement supported, with travel within the Welkom area as needed. Ideal candidates will have 3+ years in insurance claims investigation or fraud detection, strong analytical and interviewing skills, and proficiency in evidence

Qualifications

• Minimum 3 years of experience in insurance claims investigation or fraud detection.
• Strong analytical and interviewing skills with attention to detail.
• Proficiency in documenting evidence and writing reports.

Responsibilities

• Investigate suspicious insurance claims to identify potential fraud.
• Gather and analyze evidence from documents, statements, and digital records.
• Conduct interviews with claimants, witnesses and other parties.
• Coordinate with law enforcement, counsel and external stakeholders as needed.
• Prepare comprehensive investigation reports with findings and recommendations.
• Maintain confidential records and support claims teams with insights on fraud risks.
• Stay updated on fraud trends and testify when required.

Skills

Claims investigation

Fraud detection

Analytical thinking

Interviewing

Report writing

Insurance knowledge

Tools

Investigative software

Job description

About the Role

Our client, a leading insurance provider committed to upholding integrity, is seeking a meticulous and astute Claims Investigator to join their dedicated fraud detection unit in Welkom. This critical role involves the thorough investigation of potentially fraudulent insurance claims across various lines of business. You will be responsible for gathering evidence, conducting interviews, analyzing claim patterns, and preparing detailed reports to support or refute allegations of fraud. The position requires a sharp analytical mind, excellent investigative skills, and a strong understanding of insurance claims processes. This role offers a hybrid working arrangement, allowing for a balance between essential fieldwork and remote analysis. You will play a vital part in protecting the company's assets and maintaining trust with legitimate policyholders in Free State. Your expertise will be crucial in identifying and mitigating financial losses due to fraudulent activities, ensuring fairness and accuracy in the claims handling process for our client in Welkom.

Key Responsibilities

• Investigate suspicious insurance claims to identify potential instances of fraud, misrepresentation, or non-disclosure.
• Gather and analyze evidence, including documentation, statements, and digital records.
• Conduct interviews with claimants, witnesses, and other relevant parties.
• Liaise with law enforcement agencies, legal counsel, and other external parties as necessary.
• Prepare comprehensive investigation reports, detailing findings, evidence, and recommendations.
• Maintain accurate and confidential records of all investigations.
• Collaborate with claims handlers and underwriting teams to provide insights and support on fraud-related matters.
• Utilize investigative tools and techniques to uncover fraudulent schemes.
• Stay informed about emerging fraud trends and methodologies within the insurance industry.
• Testify in legal proceedings when required.

Requirements

• Minimum of 3 years of experience in insurance claims investigation, fraud detection, or a related investigative field.
• Proven ability to conduct thorough and discreet investigations.
• Strong analytical and critical thinking skills, with a keen eye for detail.
• Excellent interviewing and interpersonal skills.
• Proficiency in report writing and evidence documentation.
• Knowledge of insurance products and claims processes.
• Experience with relevant investigative software and databases is an advantage.
• Ability to work independently and manage multiple cases simultaneously.
• Valid driver's license and willingness to travel within the Welkom area.
• High level of integrity, discretion, and professionalism.

Benefits

Our client provides a competitive salary package, including performance-related bonuses. Employees benefit from comprehensive medical aid, a provident fund, and opportunities for specialized training in fraud investigation techniques. The hybrid model supports work-life balance. Join a respected organization dedicated to combating insurance fraud and making a tangible difference in the Free State region.