Insurance Claims Investigator

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

About the Role

Our client, a prominent insurance firm operating in Randburg , is seeking a vigilant and astute Insurance Claims Investigator to join their dedicated claims department. This role is crucial in ensuring the integrity of insurance claims by conducting thorough investigations into potentially fraudulent or suspicious cases. You will work closely with claims adjusters and legal teams to gather evidence, interview involved parties, and determine the legitimacy of claims. The position offers a hybrid work arrangement, allowing for a blend of office-based collaboration and remote work flexibility within the Gauteng area. The ideal candidate will possess strong investigative skills, a keen eye for detail, excellent analytical abilities, and a solid understanding of insurance principles. This is an excellent opportunity to play a key role in fraud prevention and detection within a respected organization. We are looking for a proactive individual who can manage a caseload efficiently, document findings meticulously, and contribute to the overall accuracy and fairness of the claims process. Your dedication to uncovering facts and upholding ethical standards will be highly valued. Contribute to protecting the company and its honest policyholders through diligent investigative work.

Key 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.

Requirements

• Bachelor's degree in Criminal Justice, Criminology, Law, or a related field is preferred.
• Minimum of 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 and manage a demanding caseload in a hybrid environment.
• High level of discretion, integrity, and attention to detail.
• Proficiency in Microsoft Office Suite and database management.
• Valid driver's license and willingness to travel within the Gauteng region.

Benefits

• Competitive salary commensurate with experience.
• Medical aid and provident fund benefits.
• Opportunities for specialized training in investigative techniques.
• Hybrid work model for flexibility.
• Paid annual leave and public holidays.
• A challenging and rewarding work environment.
• Supportive team and management.
• Career progression within the claims and investigations field.
• Contribution to mitigating financial losses due to fraud.
• Regular performance reviews and feedback.