Insurance Claims Investigator - Fraud Detection

Placements24; Benoni; Hybrid; ZAR 360,000 - 600,000; Full time

Benefits offered by this job

Fully remote work

Performance bonuses

Home office allowance

Medical and dental benefits

Retirement savings plan

Specialized training in fraud investig

Job summary

Placements24 is seeking an Insurance Claims Investigator for a fully remote role in South Africa. The position focuses on investigating suspicious claims across insurance lines, gathering evidence, interviewing relevant parties, and preparing detailed reports to detect and deter fraud.

The ideal candidate has strong analytical abilities, sharp attention to detail, excellent interviewing techniques, and a solid understanding of investigative procedures within the insurance context.

Qualifications

• 3+ years in insurance claims investigation or related field.
• Knowledge of insurance principles and fraud schemes.
• Proven interview and evidence-gathering skills.
• Ability to work independently in a remote role.

Responsibilities

• Investigate suspicious claims for fraud indicators.
• Gather evidence from documents, statements and digital data.
• Interview claimants, witnesses, and parties involved.
• Prepare detailed investigation reports with findings.
• Coordinate with police or legal teams as needed.
• Identify patterns to enhance fraud detection.
• Maintain confidential case files and records.
• Testify in proceedings if required.
• Stay updated on fraud techniques and best practices.
• Support internal controls and training programs.

Skills

Investigation

Interviewing

Analytical thinking

Fraud detection

Remote work

Ethical conduct

Education

Criminal Justice degree

Forensics background

Tools

Case management software

Digital forensics tools

Job description

About the Role

Our client, a leading insurance provider committed to upholding integrity, is seeking a diligent and perceptive Insurance Claims Investigator to join their specialized fraud detection unit. This fully remote position allows you to contribute to safeguarding the company's assets and reputation from fraudulent claims, working from any location within South Africa . You will be responsible for conducting thorough investigations into suspicious claims across various insurance lines, gathering evidence, interviewing relevant parties, and preparing detailed reports. The ideal candidate possesses strong analytical skills, a keen eye for detail, excellent interviewing techniques, and a deep understanding of investigative procedures within the insurance context. This role requires a proactive and ethical approach, ensuring all investigations are conducted discreetly and efficiently. It's a crucial role that demands integrity and a commitment to uncovering the truth. The fully remote nature of this position offers significant flexibility and work-life balance. We are looking for individuals with a background in law enforcement, claims, or investigation, who are adept at recognizing patterns and inconsistencies indicative of fraud. Your contribution will directly impact the company's financial health and customer trust. Join a team dedicated to maintaining the highest ethical standards in the insurance industry.

Key Responsibilities

• Investigate suspicious insurance claims to determine the validity and presence of fraudulent activity.
• Gather and analyze evidence, including documentation, statements, and digital records.
• Conduct interviews with claimants, witnesses, and other relevant parties.
• Prepare comprehensive investigation reports, detailing findings and recommendations.
• Liaise with internal departments, law enforcement agencies, and legal counsel as required.
• Identify patterns and trends in fraudulent claims to improve detection strategies.
• Maintain accurate and confidential case files and records.
• Testify in legal proceedings if required.
• Stay updated on fraud detection techniques and industry best practices.
• Contribute to the development of internal controls and training programs to prevent fraud.

Requirements

• Matriculation certificate or equivalent qualification.
• A relevant tertiary qualification in Criminal Justice, Law, Forensics, or a related field is advantageous.
• Minimum of 3 years of experience in insurance claims investigation, fraud detection, or a related investigative field (e.g., law enforcement).
• Demonstrated understanding of insurance principles and common types of insurance fraud.
• Excellent investigative, analytical, and critical thinking skills.
• Proficiency in conducting interviews and gathering evidence.
• Strong report writing and documentation skills.
• Ability to work independently and manage workload effectively in a remote setting.
• Discretion, integrity, and strong ethical principles.
• Proficiency in relevant investigation tools and software.
• Must have a reliable internet connection and a suitable remote work environment.

Benefits

• Fully remote working arrangement.
• Competitive salary commensurate with experience.
• Performance-based bonuses.
• Allowance for home office expenses.
• Comprehensive medical and dental benefits.
• Retirement savings plan.
• Opportunities for specialized training in fraud investigation.
• Supportive and ethical work culture.
• Flexible working hours.