Senior Claims Manager - Special Investigations Unit

Placements24; Pretoria; On-site; ZAR 1,200,000 - 2,400,000; Full time

Benefits offered by this job

Competitive executive salary package

Annual performance-based bonus

Premium medical aid coverage

Generous vacation and personal leave

Job summary

Placements24 seeks a Senior Claims Manager to head the Special Investigations Unit in Pretoria, Gauteng. You will direct investigations into fraudulent claims, policy breaches, and high-risk scenarios, while coordinating with law enforcement and legal counsel.

You will lead a team of investigators, develop strategies, and ensure regulatory and policy compliance in a high-stakes environment. Strong leadership and investigative expertise are essential for success.

Qualifications

• Minimum 10 years in insurance claims investigation or related field with leadership experience.
• Proven experience managing complex investigations and leading teams.
• Knowledge of fraud schemes, investigative techniques and legal frameworks.
• Willingness to travel within Gauteng and beyond as required for investigations.

Responsibilities

• Lead and manage the Special Investigations Unit, overseeing all aspects of claim fraud detection and investigation.
• Develop and implement comprehensive investigation strategies and protocols.
• Conduct thorough investigations into suspected fraudulent claims, policy breaches, and other irregularities.
• Manage and mentor a team of investigators, providing guidance and performance oversight.
• Liaise effectively with internal departments, legal counsel, law enforcement agencies, and external experts.
• Analyze investigation findings and prepare detailed reports with actionable recommendations.
• Ensure compliance with all relevant laws, regulations, and company policies.
• Contribute to the development and delivery of anti-fraud training programs for staff.
• Maintain the confidentiality and integrity of all investigation-related information.
• Represent the company in legal proceedings or regulatory inquiries related to investigations when required.

Skills

Leadership

Analytical thinking

Communication

Negotiation

Interpersonal skills

Problem-solving

Collaboration with law enforcement

Education

Certified Fraud Examiner (CFE)

Tools

Investigation management software

Reporting tools

Job description

About the Role

Our client, a leading financial services group, is seeking a highly experienced and astute Senior Claims Manager to spearhead their Special Investigations Unit (SIU) in Pretoria , Gauteng . This crucial role demands a meticulous and proactive leader capable of directing complex investigations into fraudulent claims, policy violations, and other high-risk scenarios. The Senior Claims Manager will be responsible for developing and executing investigation strategies, leading a team of skilled investigators, and collaborating closely with law enforcement agencies and legal counsel. This is a challenging yet rewarding opportunity for a dedicated professional to contribute to the integrity and financial health of our client. The successful candidate will possess a keen eye for detail, a strong understanding of investigative procedures, and an unwavering commitment to ethical practices. You will play a vital role in mitigating losses and upholding the company's reputation for fairness and security. This position offers significant autonomy and the chance to implement robust anti-fraud measures within a highly respected organization operating in the heart of South Africa's administrative capital. The role requires a strategic thinker who can navigate complex legal and investigative landscapes.

Key Responsibilities

• Lead and manage the Special Investigations Unit, overseeing all aspects of claim fraud detection and investigation.
• Develop and implement comprehensive investigation strategies and protocols.
• Conduct thorough investigations into suspected fraudulent claims, policy breaches, and other irregularities.
• Manage and mentor a team of investigators, providing guidance and performance oversight.
• Liaise effectively with internal departments, legal counsel, law enforcement agencies, and external experts.
• Analyze investigation findings and prepare detailed reports with actionable recommendations.
• Ensure compliance with all relevant laws, regulations, and company policies.
• Contribute to the development and delivery of anti-fraud training programs for staff.
• Maintain the confidentiality and integrity of all investigation-related information.
• Represent the company in legal proceedings or regulatory inquiries related to investigations when required.

Requirements

• A minimum of 10 years of experience in insurance claims investigation, fraud detection, or a related field, with a substantial portion in a leadership role.
• Proven experience managing complex investigations and leading investigative teams.
• In-depth knowledge of fraud schemes, investigative techniques, and relevant legal frameworks.
• Strong analytical, critical thinking, and problem-solving skills.
• Excellent communication, negotiation, and interpersonal abilities.
• Experience collaborating with law enforcement and legal professionals.
• Relevant certifications in fraud examination (e.g., CFE) are highly advantageous.
• Proficiency in investigation management software and reporting tools.
• Demonstrated ability to maintain objectivity and discretion in sensitive matters.
• Willingness to travel within Gauteng and potentially beyond as required for investigations.

Benefits

• Highly competitive executive salary package.
• Substantial annual performance-based bonus.
• Premium medical aid coverage and robust retirement plan.
• Generous vacation and personal leave allowances.
• Exceptional opportunities for professional development, including specialized investigative training.
• Access to state-of-the-art investigative tools and resources.
• A challenging and rewarding work environment in Pretoria .
• Leadership role with significant strategic impact.
• Car allowance and travel expenses covered.