Insurance Claims Investigator

Placements24; Stellenbosch; Hybride; ZAR 300 000 - 420 000; Plein temps

Avantages offerts par ce poste

Health insurance

Hybrid work model

Professional development opportunities

Résumé du poste

Placements24 in Paarl, Western Cape is seeking an experienced Insurance Claims Investigator to diligently investigate suspicious or complex insurance claims, determine validity, identify fraud, and support fair claim resolution.

The role involves interviewing witnesses, gathering evidence, and preparing objective reports. You will collaborate with legal and fraud units in a hybrid work model that offers flexibility and opportunities for professional development within the claims sector.

Qualifications

• Experience in claims investigations or related field.
• Ability to gather evidence, interview witnesses and write reports.
• Strong knowledge of insurance processes and fraud indicators.

Responsabilités

• Conduct thorough investigations into assigned insurance claims, especially suspicious or potentially fraudulent.
• Gather and analyze evidence, including documentation, statements, and physical evidence.
• Interview claimants, witnesses, and other relevant parties to obtain information.
• Assess the validity and extent of damages or losses claimed.
• Identify potential indicators of fraud and collaborate with fraud units.
• Prepare comprehensive investigation reports with findings and recommendations.
• Liaise with legal counsel, law enforcement and other external parties as needed.
• Maintain accurate records of all investigative activities.
• Ensure compliance with policies, procedures, and regulations.
• Testify in legal proceedings when required.

Connaissances

Interviewing

Evidence collection

Report writing

Analytical thinking

Attention to detail

MS Office

Communication

Time management

Travel willingness

Formation

High school diploma

Bachelor's degree (advantage)

Outils

Microsoft Office

Description du poste

About the Role

Our client, a reputable insurance provider, is seeking a diligent and experienced Insurance Claims Investigator to join their team in Paarl, Western Cape. This role is essential for thoroughly investigating suspicious or complex insurance claims to determine validity, identify fraud, and ensure accurate claim resolution. The ideal candidate will possess strong investigative skills, excellent attention to detail, and a solid understanding of insurance principles and legal procedures. You will be responsible for gathering evidence, interviewing witnesses, and preparing detailed reports to support claim decisions. This position requires a proactive and ethical approach to investigations, ensuring fairness to all parties involved. We foster a supportive team environment and offer opportunities for professional development within the insurance claims sector. This is a key role for maintaining the integrity of our claims processes in the Paarl region. The hybrid work model offers flexibility.

Key Responsibilities

• Conduct thorough investigations into assigned insurance claims, particularly those deemed suspicious or potentially fraudulent.
• Gather and analyze evidence, including documentation, statements, and physical evidence.
• Interview claimants, witnesses, and other relevant parties to obtain information.
• Assess the validity and extent of damages or losses claimed.
• Identify potential indicators of fraud and collaborate with fraud detection units.
• Prepare comprehensive and objective investigation reports with findings and recommendations.
• Liaise with legal counsel, law enforcement agencies, and other external parties as needed.
• Maintain accurate and detailed records of all investigative activities.
• Ensure compliance with company policies, procedures, and relevant regulations.
• Testify in legal proceedings when required.

Requirements

• High school diploma or equivalent required; a Bachelor's degree is an advantage.
• Minimum of 3 years of experience in claims investigation, fraud examination, or a related investigative field, preferably within insurance.
• Demonstrated experience in interviewing, evidence collection, and report writing.
• Strong understanding of insurance claims processes and common types of insurance fraud.
• Excellent analytical, critical thinking, and problem-solving skills.
• Exceptional attention to detail and observational abilities.
• Proficiency in basic computer applications such as Microsoft Office Suite.
• Good communication and interpersonal skills, with the ability to build rapport and elicit information.
• Ability to work independently and manage time effectively.
• Valid driver's license and a willingness to travel within the Paarl, Western Cape area for investigations.

Benefits

Our client offers a competitive salary, health insurance, retirement plan options, and opportunities for specialized training in fraud investigation techniques. Employees benefit from a supportive team environment in Paarl, Western Cape , and a hybrid work schedule. The company values integrity and diligence. Additional benefits include performance bonuses and paid time off. We are committed to ensuring fair claims handling and protecting against fraudulent activity.