Insurance Claims Investigator

Placements24; Kempton Park; On-site; ZAR 300,000 - 420,000; Full time

Benefits offered by this job

Company vehicle and fuel allowance for

Comprehensive medical benefits

Retirement benefits

Annual performance bonuses

Opportunities for specialized fraud-ds

Job summary

Placements24 is seeking an Insurance Claims Investigator for our client in Gauteng, focusing on thorough investigations to determine liability, assess damages, and prevent fraud. The role requires interviewing claimants, witnesses, and involved parties, gathering evidence, and ensuring compliance with industry regulations.

Based in Tembisa area with travel within surrounding regions. The position offers a stable career path with opportunities for professional development, a supportive team, and

Qualifications

• Matric (Grade 12) is essential; a Diploma or Degree in Criminal Justice, Law or Risk Management is advantageous.
• 3–5 years' experience as a Claims Investigator, Detective, or in a similar investigative role in insurance or law enforcement.
• Solid understanding of insurance policies, claims processes and fraud detection techniques.
• Excellent interviewing, observational and analytical skills.
• Strong research abilities and ability to gather information from multiple sources.
• Exceptional report writing to present facts clearly and concisely.
• Knowledge of South Africa's legal and regulatory insurance frameworks.
• Ability to work independently, manage time effectively and handle sensitive information.

Responsibilities

• Receive and review insurance claim forms and supporting documentation.
• Conduct investigations into suspicious or complex claims, including interviewing claimants and involved parties.
• Gather evidence such as police reports, medical records, estimates, and photographs.
• Analyze findings to determine liability, coverage, and potential fraud or misrepresentation.
• Prepare detailed investigation reports documenting activities, findings, and conclusions.
• Liaise with policyholders, legal representatives, police and other relevant parties.
• Attend court hearings to present findings when required.
• Maintain accurate records of investigations and claim activities.

Skills

Interviewing

Observational skills

Analytical thinking

Report writing

Fraud detection

Research

Education

Matric (Grade 12)

Diploma in Criminal Justice

Degree in Law or Risk Management

Tools

MS Word

Database management

Job description

About the Role

Our client, a distinguished provider of comprehensive insurance solutions, is seeking a meticulous and dedicated Insurance Claims Investigator to join their esteemed team in Tembisa, Gauteng. This role is critical to ensuring the integrity and efficiency of our claims processing system. The ideal candidate will be responsible for conducting thorough investigations into insurance claims to determine liability, assess damages, and prevent fraudulent activities. This position offers a unique opportunity to become an integral part of a stable and growing industry, contributing directly to customer satisfaction and company reputation. Based in Tembisa, this role requires a strong presence within the local community and a commitment to upholding the highest standards of professional conduct. We are dedicated to providing our employees with a stable career path and the resources needed to excel.

Key Responsibilities

• Receive and review insurance claim forms and supporting documentation.
• Conduct thorough investigations into suspicious or complex claims, which may include interviewing claimants, witnesses, and involved parties.
• Gather evidence, such as police reports, medical records, repair estimates, and photographic documentation.
• Analyze findings to determine the validity and extent of coverage, identifying potential fraud or misrepresentation.
• Prepare detailed investigation reports, documenting all activities, findings, and conclusions.
• Liaise with policyholders, legal representatives, law enforcement agencies, and other relevant parties.
• Assess the extent of damages or losses and recommend appropriate settlement amounts based on policy terms and investigation findings.
• Attend court hearings or legal proceedings when required to present findings.
• Ensure compliance with all relevant insurance regulations and company policies.
• Maintain accurate and up-to-date records of all investigations and claim activities.

Requirements

• A Matriculation Certificate (Grade 12) is essential; a diploma or degree in a relevant field (e.g., Criminal Justice, Law, Risk Management) is advantageous.
• Proven experience (3-5 years) as a Claims Investigator, Detective, or in a similar investigative role within the insurance industry or law enforcement.
• Strong understanding of insurance policies, claims processes, and fraud detection techniques.
• Excellent interviewing, observational, and analytical skills.
• Proficiency in conducting research and gathering information from various sources.
• Exceptional report-writing skills with the ability to present facts clearly and concisely.
• Good knowledge of relevant legal and regulatory frameworks governing insurance claims in South Africa.
• Ability to work independently, manage time effectively, and handle sensitive information with discretion.
• Valid driver's license and willingness to travel within the Tembisa area and surrounding regions.
• Proficiency in standard office software, including word processing and database management.

Benefits

• Competitive salary commensurate with experience and qualifications.
• Company vehicle and fuel allowance for business travel.
• Comprehensive medical and retirement benefits.
• Opportunities for specialized training in fraud detection and investigation techniques.
• A stable and secure employment environment within a reputable organization.
• Clear career progression pathways within the claims department.
• Supportive management and team environment.
• Annual performance bonuses.
• Employee assistance programs.
• Opportunities to contribute to the community by ensuring fair claims handling.