Claims Investigator - Fraud Detection

Placements24; Centurion; Híbrido; ZAR 300.000 - 540.000; Tempo integral

Benefícios oferecidos por esta vaga

Health insurance

Retirement benefits

Hybrid work model

Resumo da vaga

Placements24 seeks a Claims Investigator specializing in Fraud Detection in Centurion, Gauteng. The role focuses on identifying and investigating fraudulent insurance claims, gathering evidence, interviewing claimants and witnesses, and coordinating with internal teams to protect assets.

Strong analytical skills and knowledge of fraud schemes are essential. The ideal candidate will be based in Centurion or willing to commute, with experience in insurance claims and regulatory awareness.

Qualificações

• 3+ years of experience in insurance claims investigation or related field.
• Proven ability to gather evidence and prepare reports.
• Strong analytical and interviewing skills; attention to detail.
• Familiarity with insurance policies, fraud schemes and regulatory context.

Responsabilidades

• Identify potential fraud in insurance claims through data analysis.
• Conduct thorough investigations and document findings.
• Interview claimants, witnesses and relevant parties.
• Analyze policy details and claim histories for inconsistencies.
• Coordinate with claims, legal and underwriting teams.
• Prepare detailed investigation reports with recommendations.
• Collaborate with law enforcement when needed and maintain records.
• Stay updated on fraud trends and investigative techniques.

Conhecimentos

Insurance claims investigation

Data analysis

Interviewing

Fraud detection

Ferramentas

MS Office

Descrição da vaga

About the Role

Our client, a distinguished player in the insurance sector, is seeking a sharp and diligent Claims Investigator specializing in Fraud Detection to join their esteemed team in Centurion, Gauteng . This crucial role focuses on identifying, investigating, and preventing fraudulent insurance claims, safeguarding the company's assets and maintaining the integrity of the insurance process. The ideal candidate will possess a keen eye for detail, strong analytical skills, and a thorough understanding of investigative techniques within the insurance context. This is an excellent opportunity for a proactive professional to make a significant impact within a respected organization, contributing to the financial health and reputation of the company from their base in Centurion .

Key Responsibilities

• Proactively identify potential fraudulent insurance claims through data analysis and review of claim files.
• Conduct comprehensive investigations into suspected fraudulent activities, gathering evidence, and documenting findings.
• Interview claimants, witnesses, and other relevant parties to obtain information and assess credibility.
• Analyze financial records, policy details, and claim histories to uncover discrepancies and patterns indicative of fraud.
• Liaise with internal departments, including claims, legal, and underwriting, to share information and coordinate investigative efforts.
• Prepare detailed investigation reports outlining findings, evidence, and recommendations for action.
• Collaborate with law enforcement agencies and external partners when necessary to pursue legal action against perpetrators of insurance fraud.
• Maintain accurate and confidential records of all investigations and findings.
• Stay updated on emerging fraud trends, investigative techniques, and relevant legislation impacting the insurance industry.
• Contribute to the development and implementation of fraud prevention strategies and training programs.
• Must be based in or willing to commute to Centurion, Gauteng .

Requirements

• A minimum of 3 years of experience in insurance claims investigation, fraud detection, or a related investigative field.
• Proven ability to conduct thorough investigations, gather evidence, and produce comprehensive reports.
• Strong analytical and critical thinking skills, with a talent for identifying subtle inconsistencies.
• Excellent interviewing and interpersonal skills, with the ability to establish rapport and elicit information.
• Familiarity with insurance policies, claims processes, and common fraud schemes.
• Knowledge of relevant legal and regulatory frameworks pertaining to insurance fraud.
• Proficiency in data analysis tools and standard office software.
• A detail-oriented approach and a high degree of integrity and discretion.
• Must be based in or willing to commute to Centurion, Gauteng .

Benefits

• Our client offers a competitive salary commensurate with experience, accompanied by attractive performance incentives.
• Comprehensive health insurance, life cover, and retirement benefits are provided.
• Excellent opportunities for professional growth and specialized training in fraud investigation are available.
• The role offers a hybrid work model, combining focused office-based investigative work with the flexibility of remote work.
• Join a dedicated team in a stimulating environment in Centurion .