Fraud-Detecting Insurance Claims Investigator (Hybrid)

Placements24; Randburg; Hybrid; ZAR 360,000 - 520,000; Full time

Benefits offered by this job

Hybrid work model

Medical aid and provident fund

Training in investigative techniques

Career progression

Paid annual leave

Job summary

Placements24 is seeking an Insurance Claims Investigator for a Randburg-based insurer. You will conduct thorough investigations into potentially fraudulent claims, gather evidence, interview claimants and witnesses, and prepare detailed reports to support claims decisions.

In a hybrid Gauteng setup, the role requires 3+ years in claims investigation, strong analytical and interviewing skills, and a solid understanding of insurance policies.

Qualifications

• Bachelor's degree in Criminal Justice, Criminology, Law, or related field preferred.
• Minimum 3 years of experience in claims investigation, fraud detection, or law enforcement.
• Strong understanding of insurance policies and claims processes.
• Excellent investigative, analytical, and critical thinking skills.
• Proficiency in evidence gathering and report writing.
• Strong interviewing and interpersonal skills.
• Ability to work independently in a hybrid environment.
• High discretion, integrity, and attention to detail.
• Proficiency in Microsoft Office Suite and database management.
• Valid driver's license and willingness to travel within Gauteng.

Responsibilities

• Conduct thorough investigations into suspicious or potentially fraudulent insurance claims across various lines of business.
• Gather and analyze evidence, including reviewing claim forms, policy documents, and supporting materials.
• Interview claimants, witnesses, and other relevant parties to obtain information and statements.
• Conduct background checks and surveillance when necessary and legally permissible.
• Collaborate with law enforcement agencies and external investigators as required.
• Prepare detailed investigation reports outlining findings, conclusions, and recommendations.
• Identify patterns and indicators of fraudulent activity to improve detection methods.
• Maintain accurate and confidential records of all investigation activities.
• Testify in legal proceedings when required, presenting findings clearly and professionally.
• Ensure all investigative activities comply with legal requirements and company policies.

Skills

Investigative skills

Analytical thinking

Report writing

Interpersonal skills

MS Office

Attention to detail

Discretion

Education

Bachelor's degree in Criminal Justice/Criminology/Law

Tools

Microsoft Office Suite

Database management

Job description

Placements24 is seeking an Insurance Claims Investigator for a Randburg-based insurer. You will conduct thorough investigations into potentially fraudulent claims, gather evidence, interview claimants and witnesses, and prepare detailed reports to support claims decisions.

In a hybrid Gauteng setup, the role requires 3+ years in claims investigation, strong analytical and interviewing skills, and a solid understanding of insurance policies.