Remote Claims Investigator

Placements24; Vereeniging; Híbrido; ZAR 240.000 - 360.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote-first work model

Provident fund contributions

Paid time off

Descripción de la vacante

Placements24 is seeking a meticulous Remote Claims Investigator to join our fully remote operations. You will conduct comprehensive investigations into insurance claims, gather evidence, interview parties, and assess validity while maintaining strict confidentiality.

Ideal candidates have experience in claims investigation, strong analytical skills, and the ability to work independently in a remote setting.

Formación

• Proven experience in claims investigation, fraud detection, or related investigative field.
• Strong analytical and critical thinking skills with the ability to interpret complex information.
• Excellent interviewing and communication skills, both written and verbal.

Responsabilidades

• Conduct thorough investigations into assigned insurance claims, gathering all relevant facts and evidence.
• Interview claimants, witnesses, and other relevant parties to obtain statements and information.
• Review policy documents, claim forms, and supporting evidence to assess claim validity.
• Identify and pursue leads related to potential fraudulent activity, escalating as necessary.
• Collect and analyze documentation, including incident reports, medical records, and financial statements.
• Prepare detailed investigation reports summarizing findings, conclusions, and recommendations.
• Maintain accurate and organized case files, documenting all investigative activities and communications.
• Liaise with internal claims handlers, legal counsel, and other stakeholders to provide investigative updates.
• Ensure compliance with all relevant laws, regulations, and company policies.
• Utilize various investigative tools and techniques to gather information effectively.

Conocimientos

Claims investigation

Fraud detection

Analytical thinking

Interviewing

Herramientas

Case management software

Descripción del empleo

About the Role

Our client, a forward-thinking insurance company, is seeking a diligent and thorough Remote Claims Investigator to join their fully remote operations team. This position is ideal for individuals who possess a keen eye for detail and are adept at gathering information and evidence to support the claims assessment process. You will be responsible for conducting comprehensive investigations into insurance claims to determine validity, identify potential fraud, and ensure accurate claim resolution. Operating in a remote-first capacity, this role offers significant flexibility while requiring a high degree of autonomy and professionalism to serve clients across the nation.

Key Responsibilities

• Conduct thorough investigations into assigned insurance claims, gathering all relevant facts and evidence.
• Interview claimants, witnesses, and other relevant parties to obtain statements and information.
• Review policy documents, claim forms, and supporting evidence to assess claim validity.
• Identify and pursue leads related to potential fraudulent activity, escalating as necessary.
• Collect and analyze documentation, including incident reports, medical records, and financial statements.
• Prepare detailed investigation reports summarizing findings, conclusions, and recommendations.
• Maintain accurate and organized case files, documenting all investigative activities and communications.
• Liaise with internal claims handlers, legal counsel, and other stakeholders to provide investigative updates.
• Ensure compliance with all relevant laws, regulations, and company policies.
• Utilize various investigative tools and techniques to gather information effectively.

Requirements

• Proven experience in claims investigation, fraud detection, or a related investigative field, preferably within the insurance industry.
• Strong analytical and critical thinking skills with the ability to interpret complex information.
• Excellent interviewing and communication skills, both written and verbal.
• High level of integrity and ethical conduct.
• Ability to work independently, manage time effectively, and prioritize tasks in a remote setting.
• Proficiency in using digital tools for research, communication, and case management.
• A dedicated workspace with a reliable internet connection is required for this role.
• Experience with insurance claim processes and policy interpretation is a significant advantage.
• Ability to maintain confidentiality and handle sensitive information with discretion.
• Must be a South African citizen or hold valid work authorization.

Benefits

• Competitive annual salary of .
• Fully remote position offering significant work-life balance flexibility.
• Opportunities for specialized training in fraud detection and investigative techniques.
• A supportive and collaborative remote team environment.
• Contribution towards a provident fund.
• Exposure to a wide range of insurance claims and investigative challenges.
• Paid time off and other standard employment benefits.