Senior Claims Investigator - Fraud Detection

Placements24; Randburg; Híbrido; ZAR 600.000 - 1.000.000; Jornada completa

Descripción de la vacante

Placements24 is seeking a Senior Claims Investigator for a fully remote role in South Africa. Lead the fraud detection unit, develop analytics, and drive investigations across lines of business from a flexible, remote setting in Gauteng and beyond.

You will guide teams, liaise with law enforcement, and stay ahead of evolving fraud typologies while upholding the highest standards of integrity and accuracy in claims assessments.

Formación

• Minimum 7 years of experience in insurance claims investigation with fraud focus.
• Experience with investigative techniques and interview methodologies.
• Knowledge of insurance policies, claims processes and relevant legal frameworks.

Responsabilidades

• Conduct in-depth investigations into suspected fraudulent insurance claims.
• Develop and refine fraud detection models, analytics and investigative techniques.
• Analyze claim data to identify patterns, red flags and indicators of fraud.
• Collaborate with claims handlers, legal teams and internal departments to manage fraud cases.
• Liaise with external agencies including law enforcement and regulatory bodies.
• Prepare detailed investigation reports and present findings to management.
• Provide training to claims staff on fraud awareness and prevention.
• Stay current with emerging trends and typologies in insurance fraud.

Conocimientos

Analytical skills

Data mining

Investigation techniques

Report writing

Presentation skills

Educación

Bachelor's degree in Criminology/Law/Forensic Science/Business

Herramientas

Fraud detection software

Descripción del empleo

About the Role

Our client, a major insurance provider known for its robust fraud prevention measures, is seeking a highly experienced Senior Claims Investigator to lead their fraud detection unit. This is a fully remote position, offering a dynamic opportunity to identify, investigate, and prevent fraudulent insurance claims across various lines of business. The ideal candidate will possess exceptional analytical, investigative, and critical thinking skills, coupled with a deep understanding of insurance fraud schemes and detection methodologies. You will be instrumental in developing and implementing advanced fraud detection strategies, conducting complex investigations, and collaborating with internal stakeholders and external law enforcement agencies. Join a cutting-edge team dedicated to protecting the company and its policyholders from financial losses due to fraud, all within a flexible, remote work environment. This role demands a proactive and resourceful individual committed to upholding integrity in the insurance sector within Gauteng. Your expertise will be vital in safeguarding the company's assets.

Key Responsibilities

• Conduct in-depth investigations into suspected fraudulent insurance claims, gathering evidence and documenting findings.
• Develop and refine fraud detection models, analytics, and investigative techniques.
• Analyze claim data, identifying patterns, red flags, and potential indicators of fraud.
• Collaborate with claims handlers, legal teams, and other internal departments to manage fraud cases.
• Liaise with external agencies, including law enforcement and regulatory bodies, as required.
• Prepare detailed investigation reports and present findings to management and relevant stakeholders.
• Provide training and guidance to claims staff on fraud awareness and prevention.
• Stay current with emerging trends and typologies in insurance fraud.

Requirements

• A Bachelor's degree in Criminology, Law, Forensic Science, Business, or a related field.
• A minimum of 7 years of experience in insurance claims investigation, with a significant focus on fraud detection and prevention.
• Demonstrated expertise in investigative techniques, evidence gathering, and interview methodologies.
• Strong analytical and data mining skills, with experience using fraud detection software or tools.
• Excellent report writing and presentation abilities.
• Knowledge of insurance policies, claims processes, and relevant legal frameworks.
• Ability to work independently, manage sensitive information with discretion, and meet strict deadlines in a remote setting.
• Professional certifications in fraud investigation (e.g., CFE) are a strong asset.

Benefits

• Highly competitive salary and performance-based bonus structure.
• Comprehensive medical aid, life insurance, and retirement benefits.
• Significant opportunities for professional development and specialized training.
• The autonomy and flexibility of a fully remote work arrangement.
• The chance to work on complex and impactful fraud investigations for a leading insurer.
• Access to advanced forensic tools and analytical platforms.