Senior Claims Investigator - Remote

Placements24; Mbombela (Nelspruit); Hybrid; ZAR 900,000 - 1,100,000; Full time

Benefits offered by this job

Remote work

Health insurance

Dental coverage

Vision coverage

Retirement plan with company match

Professional development

Cutting-edge investigative tools

Collaborative remote-first culture

Job summary

Placements24 is seeking a highly experienced Senior Claims Investigator to join a fully remote claims department. You will lead complex investigations of high-value claims, gather and verify evidence, and collaborate with stakeholders to determine validity and fair settlements.

Ideal candidates bring strong investigative techniques, fraud detection expertise, and exceptional written and verbal communication skills, with the ability to work independently in a remote setting and mentor junior

Qualifications

• 6+ years of experience in insurance claims investigation, focusing on complex/high-value claims.
• Proven ability to identify and investigate fraud and verify information.
• Strong analytical and problem-solving skills with excellent report writing.

Responsibilities

• Conduct thorough investigations into complex insurance claims (property, casualty, liability).
• Gather evidence, interview, analyze documents, verify information for claim validity and loss extent.
• Identify fraud indicators and potential fraud, waste, and abuse.
• Prepare detailed investigative reports with findings and recommendations.

Skills

Investigative techniques

Fraud detection

Analytical thinking

Communication

Report writing

Education

Professional certifications in claims investigation

Tools

Claims management software

Investigative tools

Job description

About the Role

Our client, a leading national insurer, is actively recruiting a highly experienced Senior Claims Investigator to join their expanding, fully remote claims department. This role is critical in managing and investigating complex insurance claims, ensuring accuracy, fairness, and adherence to policy terms and regulatory standards. As a remote-first professional, you will leverage advanced investigative techniques, digital tools, and collaborate effectively with a dispersed team. The ideal candidate will possess a proven track record in uncovering facts, verifying information, and making sound judgments on claim validity, often dealing with high-value or potentially fraudulent cases. This is an exceptional opportunity to utilize your extensive expertise in a dynamic and supportive remote work environment, contributing significantly to our client's commitment to integrity and efficient claims resolution. You will be a key asset in maintaining trust and ensuring responsible claims handling.

Key Responsibilities

• Conduct thorough and complex investigations into insurance claims, including property, casualty, and liability.
• Gather evidence, conduct interviews, analyze documentation, and verify information to determine claim validity and extent of loss.
• Identify and investigate potential instances of fraud, waste, and abuse.
• Prepare detailed and comprehensive investigation reports, presenting findings and recommendations.
• Liaise effectively with policyholders, witnesses, legal counsel, and other relevant parties.
• Manage a caseload of complex claims, ensuring timely resolution and adherence to service level agreements.
• Provide expert guidance and support to junior investigators and claims handlers.
• Stay updated on investigative techniques, legal precedents, and industry best practices.
• Collaborate with internal and external stakeholders to resolve disputes and facilitate fair claim settlements.
• Maintain accurate and confidential records of all investigative activities.

Requirements

• Minimum of 6 years of experience in insurance claims investigation, with a strong focus on complex and high-value claims.
• Demonstrated expertise in investigative techniques, evidence gathering, and interview methodologies.
• In-depth knowledge of insurance policies, claims procedures, and relevant legal frameworks.
• Proven ability to identify and investigate fraudulent claims.
• Excellent analytical, critical thinking, and problem-solving skills.Exceptional written and verbal communication skills, with strong report-writing capabilities.
• Proficiency in using claims management software and investigative tools.
• Ability to work independently, manage workload effectively, and maintain high productivity in a remote setting.
• Relevant professional certifications in claims investigation or fraud detection are highly desirable.
• Strong ethical compass and commitment to maintaining confidentiality.

Benefits

• Highly competitive annual salary, potentially up Rands .
• Fully remote position offering unparalleled work flexibility and autonomy.
• Comprehensive health, dental, and vision insurance coverage.
• Generous retirement savings plan with company matching.
• Opportunities for continuous professional development and advanced training.
• Access to cutting-edge investigative technology and resources.
• A supportive and collaborative remote-first company culture.
• Be part of a reputable organization known for its integrity in the insurance sector.
• Potential for career advancement into leadership roles within the claims division.