Senior Claims Investigator

Placements24; Willows (CA); On-site; USD 21,000 - 37,000; Full time

Benefits offered by this job

Medical aid

Provident fund

Professional development

Job summary

Placements24 is seeking a Senior Claims Investigator for our client, a reputable insurance company, in Welkom, Free State. The role focuses on in-depth investigations into complex and potentially fraudulent insurance claims, ensuring integrity of the claims process and protecting assets.

The ideal candidate has strong interviewing and analytical skills, experience with policy terms and fraud indicators, and can liaise with law enforcement and legal counsel.

Qualifications

• A relevant tertiary qualification in policing, criminology, law, or a related field.
• Minimum 6 years' experience in insurance claims investigation, fraud detection, or law enforcement.
• Proven ability to conduct interviews, collect evidence, and write detailed reports.
• Strong understanding of insurance policies, claims processes, and fraud typologies.
• High integrity, discretion, and ability to manage multiple cases independently.

Responsibilities

• Plan, organize, and conduct thorough investigations into suspicious and complex insurance claims.
• Gather and analyze evidence, including interviewing witnesses, claimants, and involved parties.
• Document all investigative findings meticulously in detailed reports.
• Identify potential fraud indicators and apply appropriate investigation methodologies.
• Liaise with internal departments, law enforcement agencies, and legal counsel as necessary.
• Assess the validity of claims based on investigation findings and policy terms.
• Provide expert testimony in legal proceedings when required.
• Maintain confidentiality and adhere to strict ethical and legal standards.
• Recommend appropriate actions based on investigation outcomes, such as claim denial or prosecution referral.
• Stay current with fraud trends, investigative techniques, and relevant legislation.

Skills

Interviewing

Evidence collection

Report writing

Analytical thinking

Travel ready

Education

Diploma in Policing, Criminology, or Law

Tools

Microsoft Office Suite

Investigation management software

Job description

About the Role

Our client, a reputable insurance company, is looking for a seasoned Senior Claims Investigator to join their dedicated team in Welkom, Free State . This critical role involves conducting in-depth investigations into complex and potentially fraudulent insurance claims, ensuring the integrity of the claims process and protecting the company's assets. The ideal candidate will possess exceptional investigative skills, a sharp analytical mind, and a thorough understanding of insurance fraud indicators and investigation techniques. This is a challenging yet rewarding position that plays a vital part in maintaining the trust and fairness of our client's operations within the Welkom community. We seek a proactive and meticulous individual committed to uncovering the facts and ensuring just outcomes.

Key Responsibilities

• Plan, organize, and conduct thorough investigations into suspicious and complex insurance claims.
• Gather and analyze evidence, including interviewing witnesses, claimants, and involved parties.
• Document all investigative findings meticulously in detailed reports.
• Identify potential fraud indicators and apply appropriate investigation methodologies.
• Liaise with internal departments, law enforcement agencies, and legal counsel as necessary.
• Assess the validity of claims based on investigation findings and policy terms.
• Provide expert testimony in legal proceedings when required.
• Maintain confidentiality and adhere to strict ethical and legal standards.
• Recommend appropriate actions based on investigation outcomes, such as claim denial or prosecution referral.
• Stay current with fraud trends, investigative techniques, and relevant legislation.

Requirements

• A relevant tertiary qualification or a diploma in Policing, Criminology, Law, or a related field.
• A minimum of 6 years of experience in insurance claims investigation, fraud detection, or law enforcement.
• Proven experience in conducting interviews, evidence collection, and report writing.
• Strong understanding of insurance policies, claims processes, and fraud typologies.
• Excellent analytical, critical thinking, and problem-solving skills.
• High level of integrity, discretion, and ethical conduct.
• Proficiency in Microsoft Office Suite and investigation management software.
• Ability to work independently, manage multiple cases, and meet deadlines.
• A valid driver's license and willingness to travel within Welkom, Free State and surrounding areas.
• Experience with surveillance techniques is a plus.

Benefits

Our client offers a competitive salary, commensurate with experience, along with comprehensive benefits including medical aid, a provident fund, and opportunities for ongoing professional development. The company culture is one of integrity, diligence, and teamwork, providing a supportive environment for its employees. This role is based in Welkom, Free State , offering a stable career path within a well-respected insurance firm. We invest in our employees' growth and provide the tools and training necessary to excel in their roles, ensuring they are equipped to handle the complexities of modern insurance investigations.