Insurance Fraud Investigator

Placements24; Windsor Park (TN); On-site; USD 15,000 - 21,000; Full time

Benefits offered by this job

Competitive salary

Medical aid

Retirement fund

Forensic training

Overtime

Job summary

Placements24 is seeking an Insurance Fraud Investigator to join our client in East London, Eastern Cape. The role involves detecting, investigating, and preventing fraudulent insurance claims across lines of business.

You will gather evidence, interview claimants and witnesses, analyze claim data, and collaborate with internal teams and external law enforcement to resolve fraud cases. The ideal candidate has at least 3 years of experience, strong analytical and communication skills, and a solid

Qualifications

• Minimum of 3 years of experience in insurance fraud investigation or related field.
• Strong understanding of insurance principles and claim handling procedures.
• Proven experience in evidence gathering, interviewing techniques, and report writing.
• Excellent analytical, critical thinking, and problem-solving skills.
• High level of integrity, discretion, and ethical conduct.
• Strong observational skills and attention to detail.
• Proficiency in using investigative tools and databases.
• Excellent communication and interpersonal skills, both written and verbal.
• Ability to work independently and manage multiple cases simultaneously.
• Knowledge of relevant South African laws pertaining to fraud and investigations is advantageous.

Responsibilities

• Investigate suspicious insurance claims to determine the extent of potential fraud.
• Gather and analyze evidence, including documentation, interviews, and background checks.
• Conduct surveillance and covert investigations when necessary and legally permissible.
• Interview claimants, witnesses, and other relevant parties.
• Collaborate with claims adjusters, underwriters, and legal counsel to assess fraudulent activities.
• Prepare detailed investigation reports outlining findings, evidence, and recommendations.
• Liaise with law enforcement agencies and regulatory bodies regarding fraudulent cases.
• Identify patterns and trends in fraudulent claims to develop proactive prevention strategies.
• Maintain confidential investigation files and records.
• Provide training and awareness programs to internal staff on fraud detection and prevention.

Skills

Investigative skills

Analytical thinking

Interviewing techniques

Report writing

Attention to detail

Communication skills

Independent work

Tools

Investigative tools

Job description

About the Role

Our client is seeking a diligent and perceptive Insurance Fraud Investigator to join their dedicated team in East London, Eastern Cape. This critical role involves detecting, investigating, and preventing fraudulent insurance claims across various lines of business. You will meticulously gather evidence, conduct interviews, analyze claim data, and collaborate with internal departments and external law enforcement agencies to resolve fraudulent activities. The ideal candidate will possess strong investigative skills, a keen eye for detail, and a thorough understanding of insurance claim processes and fraud typologies. This is an important opportunity to uphold the integrity of the insurance system and protect our client's interests within the East London community.

Key Responsibilities

• Investigate suspicious insurance claims to determine the extent of potential fraud.
• Gather and analyze evidence, including documentation, interviews, and background checks.
• Conduct surveillance and covert investigations when necessary and legally permissible.
• Interview claimants, witnesses, and other relevant parties.
• Collaborate with claims adjusters, underwriters, and legal counsel to assess fraudulent activities.
• Prepare detailed investigation reports outlining findings, evidence, and recommendations.
• Liaise with law enforcement agencies and regulatory bodies regarding fraudulent cases.
• Identify patterns and trends in fraudulent claims to develop proactive prevention strategies.
• Maintain confidential investigation files and records.
• Provide training and awareness programs to internal staff on fraud detection and prevention.

Requirements

• Minimum of 3 years of experience in insurance fraud investigation or a related investigative field.
• Strong understanding of insurance principles and claim handling procedures.
• Proven experience in evidence gathering, interviewing techniques, and report writing.
• Excellent analytical, critical thinking, and problem-solving skills.
• High level of integrity, discretion, and ethical conduct.
• Strong observational skills and attention to detail.
• Proficiency in using investigative tools and databases.
• Excellent communication and interpersonal skills, both written and verbal.
• Ability to work independently and manage multiple cases simultaneously.
• Knowledge of relevant South African laws pertaining to fraud and investigations is advantageous.

Benefits

• Competitive salary based on experience and investigative expertise.
• Performance-based incentives for successful fraud recovery.
• Comprehensive medical aid and retirement fund options.
• Opportunities for specialized training in forensic accounting and investigative techniques.
• A supportive and team-oriented work environment in East London, Eastern Cape.
• The chance to make a tangible impact in combating insurance fraud.
• Reimbursement for professional development activities.
• Potential for overtime work.