Claims Investigator - Specialized Risks

Placements24; Paarl; Híbrido; ZAR 300.000 - 420.000; Tempo integral

Resumo da vaga

Placements24 is seeking a meticulous Claims Investigator for a hybrid role in Paarl, Western Cape. The candidate will lead investigations into complex or potentially fraudulent insurance claims, gathering evidence, interviewing parties, and producing comprehensive reports to guide claim decisions.

The ideal candidate has at least four years of claims investigation or fraud experience, strong analytical and interviewing skills, and familiarity with South African laws.

Qualificações

• Matriculation certificate (Grade 12) is essential.
• Minimum 4 years' experience in insurance claims investigation or fraud detection.
• Knowledge of SA laws and regulations relevant to investigations.
• Excellent interviewing, evidence gathering, and report-writing skills.

Responsabilidades

• Conduct thorough investigations into suspicious or complex insurance claims to determine validity and potential fraud.
• Gather and analyze evidence, including reviewing documentation, conducting interviews, and performing site inspections.
• Liaise with claimants, witnesses, legal representatives, and other stakeholders to obtain information.
• Prepare detailed and objective investigation reports, documenting findings, evidence, and conclusions.
• Collaborate closely with claims handlers, underwriters, and legal counsel to facilitate claim resolution.
• Identify patterns of fraudulent activity and contribute to fraud prevention strategies.
• Maintain accurate and confidential investigation case files.
• Stay updated on investigation techniques, fraud trends, and relevant legislation.

Conhecimentos

Investigation experience

Interviewing

Evidence gathering

Analytical thinking

Formação

Grade 12

Investigation training

Descrição da vaga

About the Role

Our client, a prominent insurer, is seeking a meticulous and experienced Claims Investigator to join their dedicated claims team in Paarl, Western Cape. This role focuses on investigating complex and potentially fraudulent claims across various lines of business, requiring a keen eye for detail, strong analytical skills, and a robust understanding of investigation techniques. You will be responsible for gathering evidence, interviewing relevant parties, and preparing detailed reports to support claim decisions. The successful candidate will play a vital role in mitigating losses and protecting the company from fraudulent activity. This hybrid position allows for a blend of field investigations and office-based work, offering flexibility within the Paarl and surrounding regions. Join a company that values integrity and provides a supportive environment for its investigators to thrive.

Key Responsibilities

• Conduct thorough investigations into suspicious or complex insurance claims to determine validity and potential fraud.
• Gather and analyze evidence, including reviewing documentation, conducting interviews, and performing site inspections.
• Liaise with claimants, witnesses, legal representatives, and other stakeholders to obtain information.
• Prepare detailed and objective investigation reports, documenting findings, evidence, and conclusions.
• Collaborate closely with claims handlers, underwriters, and legal counsel to facilitate claim resolution.
• Identify patterns of fraudulent activity and contribute to the development of fraud prevention strategies.
• Maintain accurate and confidential investigation case files.
• Adhere to ethical standards and legal requirements throughout all investigative processes.
• Represent the company in legal proceedings or arbitrations when required.
• Stay updated on investigation techniques, fraud trends, and relevant legislation.

Requirements

• Matriculation Certificate (Grade 12) is essential; relevant tertiary qualification or specialized investigation training is advantageous.
• A minimum of 4 years of experience in insurance claims investigation, fraud detection, or a related field (e.g., law enforcement, forensic accounting).
• Strong knowledge of insurance claims processes and common fraud schemes.
• Excellent interviewing, observational, and evidence-gathering skills.
• Proficiency in report writing and documentation.
• Strong analytical and critical thinking abilities.
• Good understanding of relevant South African laws and regulations pertaining to investigations.
• Ability to work independently, manage time effectively, and travel within the Paarl area as needed.
• Valid driver's license and reliable vehicle for fieldwork.
• Discretion and a high level of integrity.

Benefits

• Competitive salary based on experience and qualifications.
• Performance-based incentives.
• Contribution to medical aid and pension fund.
• Opportunities for specialized training in fraud investigation techniques.
• A challenging and rewarding career in claims management.
• Hybrid work model offering flexibility.
• Professional team environment in Paarl, Western Cape.