Senior Claims Investigator - Short-Term Insurance

Placements24; Stellenbosch; On-site; ZAR 540,000 - 900,000; Full time

Benefits offered by this job

Competitive salary

Medical aid

Retirement benefits

Professional development

Job summary

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

Qualifications

• 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.

Responsibilities

• 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.

Skills

Interviewing

Analytical thinking

Investigation

Fraud detection

Documentation

Education

Tertiary qualification in claims investigation

Professional certifications in insurance

Tools

Claims investigation software

MS Office

Job description

About the Role Our client, a prominent insurer, is seeking an experienced and meticulous Senior Claims Investigator to join their dedicated team in Stellenbosch, Western Cape. This critical role involves conducting in-depth investigations into complex short-term insurance claims to determine validity, identify fraud, and ensure fair settlement. The ideal candidate will possess strong analytical skills, a keen eye for detail, and a thorough understanding of insurance fraud detection methods. You will be responsible for interviewing claimants and witnesses, gathering evidence, assessing liability, and preparing detailed reports. This position offers an excellent opportunity to contribute to the integrity of the insurance process within a respected organization in the picturesque Stellenbosch region.

Key Responsibilities

• 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, photographic evidence, expert reports, and financial records.
• Assess liability and determine the validity of claims based on policy terms, conditions, and investigative findings.
• Identify and investigate potential instances of insurance fraud, employing advanced detection techniques.
• Prepare comprehensive and well-documented 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 and up-to-date 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.

Requirements

• A relevant tertiary qualification or relevant professional certifications in claims investigation or insurance.
• Minimum of 5 years of experience in claims investigation, specifically within short-term insurance.
• Demonstrated experience in fraud detection and prevention within the insurance sector.
• Strong understanding of South African insurance law and claims handling procedures.
• Excellent interviewing, analytical, and critical thinking skills.
• Proficiency in report writing and evidence management.
• Ability to work independently and manage a caseload effectively.
• Strong interpersonal skills and the ability to build rapport with diverse individuals.
• Proficiency in relevant claims investigation software and MS Office Suite.
• Must be willing to work full-time in our Stellenbosch, Western Cape office.

Benefits

Our client offers a competitive salary, performance-based bonuses, and comprehensive medical aid and retirement benefits. Opportunities for continued professional development and specialized training in forensic investigation and fraud management are provided. The role is situated in a beautiful and accessible office location in Stellenbosch, Western Cape, offering a stable and supportive work environment. Join a respected insurance provider committed to upholding the highest standards of integrity and customer service.