Remote Claims Investigator - Fraud Detection

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

Benefits offered by this job

Remote-work flexibility

Medical aid

Retirement fund

Performance-based bonuses

Job summary

Placements24 is seeking a diligent Remote Claims Investigator specializing in Fraud Detection for a leading South African insurer. This fully remote role lets you apply sharp investigative skills from anywhere in South Africa while safeguarding policyholders and company assets.

You will analyze claims data, interview claimants and witnesses, gather evidence, and prepare objective reports for risk assessment.

Qualifications

• Bachelor’s degree in Criminology, Law, or Forensic Science preferred.
• Minimum 3 years in claims investigation or fraud detection in insurance.
• Proven ability to conduct thorough investigations and gather evidence.
• Strong analytical and critical thinking with meticulous attention to detail.
• Excellent interviewing and interpersonal communication skills.
• Proficiency with investigative tools and databases.
• Ability to work remotely and meet deadlines.
• High integrity and ethics.
• Understanding of insurance policies and claims procedures.
• Familiarity with legal frameworks related to insurance fraud.

Responsibilities

• Conduct thorough investigations into suspected fraudulent insurance claims across lines of business.
• Analyze claim data, policy information, and other documentation to identify red flags and anomalies.
• Interview claimants, witnesses, and other parties involved in suspicious claims.
• Gather and preserve evidence, ensuring its admissibility in legal proceedings if necessary.
• Collaborate with internal stakeholders to assess fraud risk.
• Prepare detailed and objective investigation reports outlining findings and recommendations.
• Liaise with external law enforcement agencies and regulatory bodies when required.
• Stay updated on current fraud trends, methodologies, and detection techniques.
• Maintain accurate and confidential case files and records.
• Contribute to the development and improvement of fraud detection strategies and processes.

Skills

Analytical thinking

Investigative skills

Interviewing

Interpersonal communication

Remote work discipline

Data analysis tools

Education

Bachelors degree in Criminology, Law, Forensic Science or related

Tools

Investigation tools

Data analysis software

Job description

About the Role

Our client, a leading insurer committed to upholding integrity, is seeking a diligent and analytical Remote Claims Investigator specializing in Fraud Detection . This is a fully remote position, allowing you to contribute your sharp investigative skills from anywhere within South Africa. You will play a crucial role in identifying, investigating, and preventing fraudulent insurance claims, safeguarding the company's assets and maintaining trust with genuine policyholders. The ideal candidate will possess a keen eye for detail, strong analytical capabilities, and a thorough understanding of investigative techniques and insurance claims processes. This role demands a proactive and discreet individual who can meticulously examine suspicious claims, gather evidence, and provide comprehensive reports to support decision-making. We are fostering a remote-first environment where collaboration and expertise are paramount, ensuring you have the tools and support to excel in this vital function.

Key Responsibilities

• Conduct thorough investigations into suspected fraudulent insurance claims across various lines of business.
• Analyze claim data, policy information, and other relevant documentation to identify red flags and anomalies.
• Interview claimants, witnesses, and other parties involved in suspicious claims.
• Gather and preserve evidence, ensuring its admissibility in legal proceedings if necessary.
• Collaborate with internal stakeholders, including claims adjusters, legal counsel, and management, to assess fraud risk.
• Prepare detailed and objective investigation reports outlining findings, evidence, and recommendations.
• Liaise with external law enforcement agencies and regulatory bodies when required.
• Stay updated on current fraud trends, methodologies, and detection techniques.
• Maintain accurate and confidential case files and records.
• Contribute to the development and improvement of fraud detection strategies and processes.

Requirements

• A Bachelor's degree in Criminology, Law, Forensic Science, or a related field is preferred.
• A minimum of 3 years of experience in claims investigation, fraud detection, or a similar investigative role within the insurance industry.
• Proven ability to conduct thorough investigations and gather evidence effectively.
• Strong analytical and critical thinking skills with a meticulous attention to detail.
• Excellent interviewing and interpersonal communication skills.
• Proficiency in utilizing investigative tools and databases.
• Demonstrated ability to work independently, manage workload, and meet deadlines in a remote setting.
• High level of integrity, discretion, and ethical conduct.
• Understanding of insurance policies and claims procedures.
• Familiarity with legal frameworks related to insurance fraud.

Benefits

This remote role offers a competitive salary, performance-based bonuses, and a comprehensive benefits package including medical aid and a retirement fund. Enjoy the flexibility of working from home with all necessary support provided. Our client is committed to your professional development, offering ongoing training in fraud detection techniques and investigative best practices. You will be part of a dedicated team focused on maintaining the integrity of the insurance process. We provide a collaborative and supportive remote work environment where your skills and contributions are highly valued. Join us in the fight against insurance fraud and build a rewarding career.