Senior Claims Investigator: Fraud & Complex Claims

Placements24; Stellenbosch; Presencial; ZAR 540 000 - 900 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive salary

Medical aid

Retirement benefits

Professional development

Resumo da oferta

Placements24 is seeking an experienced Senior Claims Investigator for our client, a prominent insurer, in Stellenbosch, Western Cape. The role involves conducting in-depth investigations into short-term insurance claims to determine validity, detect fraud, and support fair settlements.

The successful candidate will interview claimants and witnesses, gather evidence, assess liability, and prepare detailed reports, while staying current with industry best practices and working closely with legal

Qualificações

• A relevant tertiary qualification or professional certifications in claims investigation or insurance.
• Minimum 5 years of experience in claims investigation within short-term insurance.
• Strong fraud detection and prevention experience in the insurance sector.
• Solid knowledge of South African insurance law and claims handling procedures.

Responsabilidades

• Conduct thorough investigations into a wide range of short-term insurance claims (e.g., motor, household, commercial property).
• Interview claimants, witnesses, and other relevant parties to gather accurate information and statements.
• Collect and analyze evidence, including police reports, photographs, expert reports, and financial records.
• Assess liability and determine the validity of claims based on policy terms and investigative findings.
• Identify and investigate potential instances of insurance fraud, employing advanced detection techniques.
• Prepare comprehensive investigation reports for management and relevant stakeholders.
• Liaise with legal counsel, loss adjusters, and other third parties as required during the claims investigation process.
• Maintain accurate records of all investigative activities within the claims management system.
• Provide expert advice and support to underwriting and claims handling teams on complex cases.
• Stay current with industry best practices, fraud trends, and investigative techniques.

Conhecimentos

Interviewing

Analytical thinking

Investigation

Fraud detection

Documentation

Formação académica

Tertiary qualification in claims investigation

Professional certifications in insurance

Ferramentas

Claims investigation software

MS Office

Descrição da oferta de emprego

Placements24 is seeking an experienced Senior Claims Investigator for our client, a prominent insurer, in Stellenbosch, Western Cape. The role involves conducting in-depth investigations into short-term insurance claims to determine validity, detect fraud, and support fair settlements.

The successful candidate will interview claimants and witnesses, gather evidence, assess liability, and prepare detailed reports, while staying current with industry best practices and working closely with legal