Claims Investigator - Fraud Detection

Placements24; Stellenbosch; Hybrid; ZAR 360,000 - 540,000; Full time

Benefits offered by this job

Work from home

Performance-based incentives

Professional development

Job summary

Placements24 is seeking a vigilant and astute Claims Investigator to join its fraud-detection team. This fully remote role focuses on investigating suspicious insurance claims across portfolios, gathering evidence, analyzing data, and preparing detailed reports for decision-makers and legal proceedings.

You will work independently from a home office, collaborating with internal claims handlers and external agencies.

Qualifications

• At least 4 years in insurance claims investigation, focused on fraud.
• Strong analytical and interviewing skills with credible evidence gathering.
• Deep knowledge of policies, claims processes and fraud typologies.
• Excellent written and verbal communication for clear reports.
• Experience with investigation software and databases; able to work remotely.

Responsibilities

• Investigate suspicious insurance claims to detect fraud, misrepresentation or abuse.
• Gather and analyze evidence including documents, statements and digital footprints.
• Conduct interviews with claimants, witnesses and involved parties.
• Prepare comprehensive investigation reports with findings and recommendations.
• Collaborate with claims handlers, legal counsel and law enforcement when needed.
• Utilize investigative tools to identify red flags and fraud patterns.
• Maintain confidentiality and adhere to legal/ethical standards.
• Testify in legal proceedings when required.
• Contribute to fraud prevention strategies and training programs.

Skills

Fraud detection

Claims investigation

Data analysis

Interviewing

Report writing

Remote work

Investigation software

Education

Fraud examination certification (CFE) advantageous

Tools

Investigation software

Databases

Job description

About the Role

Our client, a distinguished leader in the insurance industry, is seeking a vigilant and astute Claims Investigator to join their dedicated fraud detection unit. This role is pivotal in safeguarding the company and its policyholders from fraudulent activities. Working in a fully remote capacity, you will conduct thorough investigations into suspicious insurance claims across various portfolios. Your expertise will involve gathering evidence, analyzing data, and preparing detailed reports to support decision-making and legal proceedings. This is an exceptional opportunity for a proactive and analytical professional to make a significant impact within a globally recognized organization, contributing to the integrity of the insurance sector from the comfort of your home office. We value thoroughness and a commitment to justice.

Key Responsibilities

• Investigate suspicious insurance claims to detect potential fraud, misrepresentation, or abuse.
• Gather and analyze relevant evidence, including documents, statements, and digital footprints.
• Conduct interviews with claimants, witnesses, and other parties involved in a claim.
• Prepare comprehensive investigation reports detailing findings, evidence, and recommendations.
• Collaborate closely with internal claims handlers, legal counsel, and external law enforcement agencies.
• Utilize various investigative tools and databases to identify red flags and patterns of fraudulent activity.
• Maintain strict confidentiality and adherence to legal and ethical standards throughout investigations.
• Testify in legal proceedings when required.
• Contribute to the development of fraud prevention strategies and training programs.

Requirements

• A minimum of 4 years of experience in insurance claims investigation, with a specific focus on fraud detection.
• Proven ability to conduct complex investigations and gather credible evidence.
• In-depth knowledge of insurance policies, claims processes, and fraud typologies.
• Excellent analytical, critical thinking, and problem-solving skills.
• Strong interviewing and interrogation techniques.
• Exceptional written and verbal communication skills, with the ability to prepare clear and concise reports.
• Proficiency in using investigation software, databases, and standard office applications.
• Ability to work independently, manage workload effectively, and maintain discretion in a remote environment.
• Relevant certifications in fraud examination (e.g., CFE) are highly advantageous.

Benefits

This fully remote position offers a competitive salary and comprehensive benefits package. Enjoy the flexibility and work-life balance of working from home, with all the necessary tools and support provided. Our client is committed to professional development, offering ongoing training and opportunities to enhance your investigative skills. You will be part of a highly respected team that plays a crucial role in the company's success and the broader insurance landscape. Additional benefits include performance-based incentives and a supportive management structure. Join an organization that values integrity, expertise, and the well-being of its remote workforce.