Claims Investigator - Fraud Detection

Placements24; Benoni; On-site; ZAR 380,000 - 520,000; Full time

Benefits offered by this job

Health insurance

Fraud investigation training

Career development

Job summary

Placements24 is seeking a vigilant Claims Investigator in Benoni to examine insurance claims for fraud indicators and conduct thorough investigations. You will gather evidence, conduct interviews, and prepare detailed reports to support fraud prevention and recoveries within the Gauteng region.

The role requires at least 3 years of claims investigation experience, strong analytical and communication skills, and a commitment to compliance with legal standards.

Qualifications

• Minimum of 3 years of experience in claims investigation focused on insurance fraud.
• Strong understanding of insurance principles and common fraud schemes.
• Excellent investigative, analytical, and critical thinking skills.
• Proficiency in conducting interviews and surveillance where legal.
• Strong report writing skills and ability to present findings clearly.
• Clean criminal record and ability to obtain licenses or certifications.

Responsibilities

• Analyze insurance claims for red flags and indicators of fraudulent activity.
• Conduct thorough investigations including background checks, asset searches, and interviews.
• Gather and preserve evidence in accordance with legal standards.
• Prepare comprehensive investigation reports documenting findings.
• Collaborate with internal legal, claims, and underwriting departments.
• Maintain up-to-date knowledge of fraud trends, detection techniques, and regulatory requirements.

Skills

Investigative skills

Analytical thinking

Interviewing skills

Report writing

Legal compliance

Job description

About the Role

Our client is looking for a vigilant and resourceful Claims Investigator with a specialization in fraud detection to join their dedicated team in Benoni . This critical role involves meticulously examining insurance claims to identify and investigate suspicious activities and potential fraudulent claims across various lines of business. You will be responsible for gathering evidence, conducting interviews, and preparing detailed reports to support fraud prevention efforts and recoveries. This position offers the chance to make a significant impact in protecting the company from financial losses within the Gauteng area.

Key Responsibilities

• Analyze insurance claims for red flags and indicators of fraudulent activity.
• Conduct thorough investigations, including background checks, asset searches, and interviews with claimants and witnesses.
• Gather and preserve evidence in accordance with legal standards for potential prosecution or recovery actions.
• Prepare comprehensive investigation reports, documenting findings and recommending appropriate actions.
• Collaborate closely with internal legal, claims, and underwriting departments.
• Maintain up-to-date knowledge of fraud trends, detection techniques, and regulatory requirements.

Requirements

• Minimum of 3 years of experience in claims investigation, specifically focused on insurance fraud.
• Strong understanding of insurance principles and common fraud schemes.
• Excellent investigative, analytical, and critical thinking skills.
• Proficiency in conducting interviews and surveillance (where applicable and legal).
• Strong report writing skills and the ability to present findings effectively.
• A clean criminal record and ability to obtain necessary licenses or certifications.

Benefits

• Competitive salary and potential for performance-based rewards.
• Comprehensive health, dental, and vision insurance plans.
• Opportunities for specialized training in fraud investigation techniques.
• Supportive team environment dedicated to combating insurance fraud.
• Vital role in safeguarding the company's financial integrity in Benoni .