Insurance Claims Investigator

Placements24; United States; Presencial; USD 24.000 - 31.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Travel reimbursement

Medical aid

Retirement fund

Professional development

Descripción de la vacante

Placements24 in Randburg, Gauteng, is seeking an experienced Insurance Claims Investigator to join the client’s team. The role focuses on verifying claim validity, gathering evidence, interviewing witnesses, and producing objective reports to inform claim decisions.

The ideal candidate has at least four years of experience in investigations, a solid understanding of insurance principles and fraud indicators, and the ability to work independently in the field.

Formación

• Matriculation (Grade 12) required; tertiary qualification or specialized investigative training/certification is advantageous.
• Minimum of 4 years of experience as an Insurance Claims Investigator, Fraud Investigator, or related role.
• Proven experience in evidence gathering, interviewing techniques, and report writing.
• Strong understanding of insurance principles and common types of insurance fraud.

Responsabilidades

• Conduct detailed investigations into insurance claims to determine validity and extent of loss.
• Interview claimants, witnesses, and relevant parties to obtain statements and gather information.
• Collect and analyze evidence, including documents, photos, and expert reports.
• Assess circumstances to identify potential fraud, misrepresentation, or policy breaches.
• Prepare detailed, objective investigation reports for the claims department.
• Collaborate with claims adjusters, underwriters, and legal counsel as needed.
• Maintain confidentiality and ethical standards during investigations.
• Stay updated on investigative techniques, legal requirements, and fraud detection.
• Visit accident scenes or claimant premises for investigations in and around Randburg.
• Testify in legal proceedings if necessary, providing clear findings.

Conocimientos

Investigations

Interviewing techniques

Report writing

Analytical thinking

Time management

Communication

MS Office

Claims software

Driver's license

Educación

Matriculation

Investigative training/certification

Herramientas

Microsoft Office Suite

Claims management software

Investigation software

Descripción del empleo

About the Role

Our client, a reputable insurance firm, is actively searching for a diligent and experienced Insurance Claims Investigator to join their operations in Randburg, Gauteng. This role is pivotal in verifying the accuracy and legitimacy of insurance claims, conducting thorough investigations to uncover facts, and providing comprehensive reports to support claim decisions. You will be responsible for gathering evidence, interviewing relevant parties, analyzing documentation, and determining if claims align with policy terms and conditions. The ideal candidate will possess strong investigative skills, excellent attention to detail, and a sound understanding of insurance fraud indicators. We are seeking a professional who can uphold our client's commitment to integrity and fairness in claim settlements within the Randburg area. This is a hands‑on role requiring field work and meticulous record‑keeping.

Key Responsibilities

• Conduct detailed investigations into various types of insurance claims to determine validity and extent of loss.
• Interview claimants, witnesses, and other relevant parties to obtain statements and gather information.
• Collect and analyze evidence, including documents, photos, and expert reports.
• Assess the circumstances surrounding the claim to identify potential fraud, misrepresentation, or policy breaches.
• Prepare detailed, objective, and factual investigation reports for the claims department.
• Collaborate closely with claims adjusters, underwriters, and legal counsel as needed.
• Maintain strict confidentiality and ethical standards throughout investigations.
• Stay updated on investigative techniques, legal requirements, and industry best practices for fraud detection.
• Visit accident scenes, business premises, or claimant residences as required for investigations in and around Randburg.
• Testify in legal proceedings if necessary, providing clear and concise findings.

Requirements

• Matriculation (Grade 12) required; relevant tertiary qualification or specialized investigative training/certification is advantageous.
• Minimum of 4 years of experience as an Insurance Claims Investigator, Fraud Investigator, or related role.
• Proven experience in evidence gathering, interviewing techniques, and report writing.
• Strong understanding of insurance principles and common types of insurance fraud.
• Excellent analytical and critical thinking skills, with a keen eye for detail.
• Ability to work independently, manage time effectively, and prioritize tasks.
• Good interpersonal skills with the ability to communicate professionally with diverse individuals.
• Proficiency in Microsoft Office Suite and experience with claims management or investigation software.
• A valid driver's license and a reliable vehicle for field investigations.
• Must reside in or be able to commute regularly to Randburg, Gauteng.

Benefits

• Competitive annual salary based on experience and qualifications.
• Reimbursement for travel expenses related to investigations.
• Comprehensive medical aid and retirement fund contributions.
• Opportunities for continuous professional development and training.
• A challenging and rewarding career in Randburg.
• Exposure to complex and interesting cases.