Lead Insurance Investigator - Remote

Placements24; Stellenbosch; Remote; ZAR 1,200,000 - 1,800,000; Full time

Benefits offered by this job

Competitive salary

Comprehensive health insurance

Retirement plan with company match

Generous paid time off

Full remote work arrangement

Professional development

Equipment & tech support

Job summary

Placements24 is seeking a Lead Insurance Investigator to manage a remote investigation unit for a respected insurer. You will lead a distributed team, conduct complex fraud investigations, and implement best forensic practices to detect and prevent fraud across lines of business.

You will oversee evidence gathering, interviews, and analysis, producing detailed reports for claims handlers, legal counsel, and management.

Qualifications

• Minimum 7 years in insurance fraud investigation, including leadership.
• Proven forensic investigation techniques, evidence handling and reporting.
• Strong knowledge of insurance policies and fraud schemes.
• Excellent analytical, critical thinking and problem-solving.
• Exceptional leadership and communication skills.
• Experience working remotely and managing multiple priorities.
• Certified Fraud Examiner (CFE) preferred.
• Strong ethics and confidentiality commitment.

Responsibilities

• Lead, mentor, and manage a team of investigators with oversight on complex cases.
• Develop and execute strategies to detect and prevent insurance fraud across lines of business.
• Conduct in-depth investigations, gather evidence, interview parties, analyze data.
• Prepare detailed reports and recommendations for claims handlers and management.
• Collaborate with law enforcement and external stakeholders when needed.
• Maintain relationships with claims, legal, and underwriting teams to share intelligence.
• Refine investigation protocols and tools to improve efficiency.
• Stay updated on fraud trends, methodologies and technologies.
• Ensure investigations comply with legal requirements and policies.
• Contribute to fraud awareness training for internal departments.

Skills

Leadership

Forensic inv.

Report writing

Analytical thinking

Interviewing

Remote work

CFE

Stakeholder management

Tools

Investigation software

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.