Insurance Claims Investigator

Placements24; Johannesburg; On-site; ZAR 360,000 - 600,000; Full time

Benefits offered by this job

Competitive salary based on experience

Travel expense reimbursement

Medical aid and retirement fund

Ongoing professional development

Challenging, rewarding Randburg-based,

Exposure to complex cases

Job summary

Placements24 is seeking an experienced Insurance Claims Investigator to join our client’s team in Randburg, Gauteng. The role involves field investigations, collecting evidence, interviewing parties, and producing detailed reports to support claims decisions.

You will work with claims adjusters and legal counsel, ensuring confidentiality and adherence to policy terms while staying updated on fraud indicators and investigative best practices. A valid driver’s license is required.

Qualifications

• Matriculation (Grade 12) required; relevant tertiary qualification or specialized investigative training/certification is advantageous.
• Minimum of 4 years of experience as an Insurance Claims Investigator, Fraud Investigator, or related role.
• Proven experience in evidence gathering, interviewing techniques, and report writing.
• Strong understanding of insurance principles and common types of insurance fraud.
• Excellent analytical and critical thinking skills, with a keen eye for detail.
• Ability to work independently, manage time effectively, and prioritize tasks.
• Good interpersonal skills with the ability to communicate professionally with diverse individuals.
• Proficiency in Microsoft Office Suite and experience with claims management or investigation software.
• A valid driver's license and a reliable vehicle for field investigations.
• Must reside in or be able to commute regularly to Randburg, Gauteng.

Responsibilities

• Conduct detailed investigations into insurance claims to determine validity and extent of loss.
• Interview claimants, witnesses, and other relevant parties to obtain statements and gather information.
• Collect and analyze evidence, including documents, photos, and expert reports.
• Assess the circumstances surrounding the claim to identify potential fraud, misrepresentation, or policy breaches.
• Prepare detailed, objective, and factual investigation reports for the claims department.
• Collaborate closely with claims adjusters, underwriters, and legal counsel as needed.
• Maintain strict confidentiality and ethical standards throughout investigations.
• Stay updated on investigative techniques, legal requirements, and industry best practices for fraud detection.
• Visit accident scenes, business premises, or claimant residences as required for investigations in and around Randburg.
• Testify in legal proceedings if necessary, providing clear and concise findings.

Skills

Investigative skills

Attention to detail

Interviewing techniques

Analytical thinking

Education

Matric/Grade 12

Tertiary qualification or investigative training

Tools

Microsoft Office

Claims management software

Job description

About the Role

Our client, a reputable insurance firm, is actively searching for a diligent and experienced Insurance Claims Investigator to join their operations in Randburg, Gauteng. This role is pivotal in verifying the accuracy and legitimacy of insurance claims, conducting thorough investigations to uncover facts, and providing comprehensive reports to support claim decisions. You will be responsible for gathering evidence, interviewing relevant parties, analyzing documentation, and determining if claims align with policy terms and conditions. The ideal candidate will possess strong investigative skills, excellent attention to detail, and a sound understanding of insurance fraud indicators. We are seeking a professional who can uphold our client's commitment to integrity and fairness in claim settlements within the Randburg area. This is a hands-on role requiring field work and meticulous record-keeping.

Key Responsibilities

• Conduct detailed investigations into various types of insurance claims to determine validity and extent of loss.
• Interview claimants, witnesses, and other relevant parties to obtain statements and gather information.
• Collect and analyze evidence, including documents, photos, and expert reports.
• Assess the circumstances surrounding the claim to identify potential fraud, misrepresentation, or policy breaches.
• Prepare detailed, objective, and factual investigation reports for the claims department.
• Collaborate closely with claims adjusters, underwriters, and legal counsel as needed.
• Maintain strict confidentiality and ethical standards throughout investigations.
• Stay updated on investigative techniques, legal requirements, and industry best practices for fraud detection.
• Visit accident scenes, business premises, or claimant residences as required for investigations in and around Randburg.
• Testify in legal proceedings if necessary, providing clear and concise findings.

Requirements

• Matriculation (Grade 12) required; relevant tertiary qualification or specialized investigative training/certification is advantageous.
• Minimum of 4 years of experience as an Insurance Claims Investigator, Fraud Investigator, or related role.
• Proven experience in evidence gathering, interviewing techniques, and report writing.
• Strong understanding of insurance principles and common types of insurance fraud.
• Excellent analytical and critical thinking skills, with a keen eye for detail.
• Ability to work independently, manage time effectively, and prioritize tasks.
• Good interpersonal skills with the ability to communicate professionally with diverse individuals.
• Proficiency in Microsoft Office Suite and experience with claims management or investigation software.
• A valid driver's license and a reliable vehicle for field investigations.
• Must reside in or be able to commute regularly to Randburg, Gauteng.

Benefits

• Competitive annual salary based on experience and qualifications.
• Reimbursement for travel expenses related to investigations.
• Comprehensive medical aid and retirement fund contributions.
• Opportunities for continuous professional development and training.
• A challenging and rewarding career in Randburg.
• Exposure to complex and interesting cases.