Lead Insurance Investigator - Remote

Placements24; Graafwater; Hybrid; ZAR 900,000 - 1,300,000; Full time

Benefits offered by this job

Competitive salary

Full remote work arrangement

Equipment provided

Career development

Job summary

Placements24 seeks a Lead Insurance Investigator to manage a remote investigation unit and lead a distributed team of investigators. You will detect and prevent fraud across multiple lines of business, gathering evidence, interviewing relevant parties, and analyzing data to produce comprehensive reports for claims handlers and management.

The role requires at least 7 years in insurance fraud investigation with leadership experience, a strong forensic skill set, and excellent analytical

Qualifications

• A minimum of 7 years in insurance fraud investigation, with leadership experience.
• Proven forensic investigation techniques and report writing.
• Strong knowledge of insurance policies, claims processes and common fraud schemes.
• Excellent analytical, critical thinking and communication skills.
• Ability to work autonomously in remote environments.
• Experience with interviews and statements.
• CFE certification is highly preferred.

Responsibilities

• Lead, mentor, and manage a remote team of investigators.
• Develop strategies to detect and prevent insurance fraud across lines.
• Conduct in-depth investigations and interviews, analyze data and gather evidence.
• Prepare detailed reports and recommendations for claims handlers and management.
• Collaborate with law enforcement and internal stakeholders.
• Improve protocols, tools, and techniques for efficiency.
• Stay updated on fraud trends and regulatory requirements.

Skills

Insurance fraud investigation

Leadership

Forensic investigation

Report writing

Interviews

Remote team management

Data analysis

Stakeholder collaboration

Compliance

Mentoring

Education

Certified Fraud Examiner (CFE)

Tools

Investigation software

Databases

Case management systems

Job description

About the Role

Our client, a respected insurer committed to upholding integrity and fairness, is seeking an experienced Lead Insurance Investigator to manage their remote investigation unit. This role requires a seasoned professional who can lead a team of investigators, conduct complex fraud investigations, and implement best practices in forensic analysis. As this is a fully remote position, the ideal candidate must possess exceptional self-discipline, strong leadership skills, and the ability to manage a distributed team effectively. You will be instrumental in detecting and preventing fraudulent claims, thereby protecting the company's assets and policyholders.

Key Responsibilities

• Lead, mentor, and manage a team of insurance investigators, providing guidance and oversight on complex cases.
• Develop and execute investigation strategies to detect and prevent insurance fraud across various lines of business.
• Conduct in-depth investigations into suspicious claims, gathering evidence, interviewing relevant parties, and analyzing financial and other data.
• Prepare detailed investigation reports, findings, and recommendations for claims handlers, legal counsel, and management.
• Collaborate with law enforcement agencies and other external stakeholders when necessary.
• Develop and maintain relationships with internal teams, including claims, legal, and underwriting, to share intelligence and insights.
• Implement and refine investigation protocols, tools, and techniques to enhance efficiency and effectiveness.
• Stay current with emerging fraud trends, methodologies, and technologies.
• Ensure all investigations are conducted in compliance with legal requirements and company policies.
• Contribute to fraud awareness training for relevant internal departments.

Requirements

• A minimum of 7 years of experience in insurance fraud investigation, with a significant portion in a leadership or supervisory role.
• Proven expertise in forensic investigation techniques, evidence handling, and report writing.
• Strong understanding of insurance policies, claims processes, and common fraud schemes.
• Excellent analytical, critical thinking, and problem-solving skills.
• Exceptional leadership, team management, and communication skills.
• Ability to work autonomously and manage multiple priorities effectively in a remote work environment.
• Proficiency in investigation software and databases.
• Experience in conducting interviews and obtaining statements.
• Relevant certifications (e.g., Certified Fraud Examiner - CFE) are highly preferred.
• A strong ethical compass and a commitment to maintaining confidentiality.

Benefits

• Competitive salary and performance-based incentives.
• Comprehensive health insurance and wellness programs.
• Retirement savings plan with employer contribution.
• Generous paid time off and holidays.
• Full remote work arrangement, offering significant flexibility.
• Opportunities for professional development and advanced training in forensic investigation.
• A supportive and collaborative team culture, despite the remote nature.
• Company-provided equipment and technology support.