Claims Investigator - Fraud Detection

Placements24; Polokwane; Hybrid; ZAR 350,000 - 550,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Placements24 is seeking a diligent Claims Investigator in Polokwane, Limpopo, focusing on detecting and preventing insurance fraud. The role blends office-based analysis with field investigations and requires strong analytical and communication skills.

You will collaborate with claims handlers, legal teams, and external agencies to review claims, gather evidence, and prepare comprehensive reports. A solid background in investigations and a clean record are essential for success in a hybrid work

Qualifications

• Bachelor's degree in Criminology, Law, Business Administration, or related field.
• 3–5 years in claims investigation, fraud detection, or law enforcement.
• Experience in interviewing, evidence gathering, and report writing.
• Strong analytical and critical thinking with attention to detail.
• Understanding of insurance principles and fraud types.
• Excellent communication, negotiation, and interpersonal skills.
• Proficiency with investigative tools/databases.
• Ability to work independently in a hybrid capacity.
• Valid driver's license and clean criminal record.

Responsibilities

• Review incoming insurance claims to identify suspicious patterns and indicators of fraud.
• Conduct thorough investigations into suspected fraudulent claims, gathering evidence through interviews, record reviews, and surveillance as appropriate.
• Analyze claim documentation, financial records, and data to establish or refute fraud.
• Prepare detailed investigation reports outlining findings, evidence and recommendations.
• Collaborate with claims adjusters, underwriters, and legal counsel for proper handling of frauds.
• Testify in legal proceedings when required, presenting findings clearly and concisely.
• Maintain confidentiality and adhere to legal/ethical standards.
• Develop and implement strategies to enhance fraud detection capabilities.
• Stay current with emerging fraud trends and investigative techniques.
• Liaise with law enforcement and fraud prevention bodies.

Skills

Analytical skills

Interviewing

Evidence gathering

Report writing

Attention to detail

Communication

Negotiation

Independent work

Education

Bachelor's in Criminology/Law/BA

Tools

Investigative databases

Job description

About the Role

Our client, a prominent player in the insurance industry, is seeking a diligent and astute Claims Investigator to focus on fraud detection within their operations in Polokwane, Limpopo . This critical role involves meticulously examining insurance claims to identify potential fraudulent activities, ensuring the company's financial integrity and minimizing losses. The successful candidate will possess strong analytical skills, a keen eye for detail, and a deep understanding of investigative techniques. This position operates under a hybrid model, offering a mix of office-based analysis and remote fieldwork. You will work closely with claims handlers, legal teams, and external agencies to conduct thorough investigations and gather evidence. The company is dedicated to upholding ethical standards and combating insurance fraud proactively.

Key Responsibilities

• Review incoming insurance claims to identify suspicious patterns and indicators of fraud.
• Conduct thorough investigations into suspected fraudulent claims, gathering evidence through interviews, record reviews, and surveillance as appropriate.
• Analyze claim documentation, financial records, and other relevant data to establish or refute fraudulent activity.
• Prepare detailed investigation reports outlining findings, evidence, and recommendations.
• Collaborate with claims adjusters, underwriters, and legal counsel to ensure proper handling of fraudulent claims.
• Testify in legal proceedings when required, presenting findings and evidence clearly and concisely.
• Maintain confidentiality and adhere to all legal and ethical standards during investigations.
• Develop and implement strategies to enhance fraud detection capabilities.
• Stay current with emerging fraud trends and investigative techniques in the insurance industry.
• Liaise with law enforcement agencies and industry fraud prevention bodies.

Requirements

• A Bachelor's degree in Criminology, Law, Business Administration, or a related field.
• Minimum of 3-5 years of experience in claims investigation, fraud detection, or law enforcement.
• Demonstrated experience in interviewing, evidence gathering, and report writing.
• Strong analytical and critical thinking skills with exceptional attention to detail.
• Understanding of insurance principles and common types of insurance fraud.
• Excellent communication, negotiation, and interpersonal skills.
• Proficiency in using investigative tools and databases.
• Ability to work independently and manage complex investigations in a hybrid capacity.
• A valid driver's license and a clean criminal record are essential.

Benefits

Our client offers a competitive salary, comprehensive medical and retirement benefits, and opportunities for specialized training in fraud investigation techniques. This role provides a chance to make a significant impact in safeguarding the company's assets and reputation. Career progression opportunities exist within the investigations and risk management departments. The hybrid work model supports a balanced approach to professional and personal life.