Talent Pool : Claims Auditor Mmh251128-20

Momentum; Gauteng; On-site; ZAR 450 000 - 600 000; Full time

Job summary

A leading insurance company is seeking a Claims Auditor to investigate the legitimacy of claims in the Johannesburg Metropolitan Area. The role requires a Bachelor's degree in a related field and 5-8 years’ experience in the insurance claims sector. Responsibilities include conducting investigations, managing client relationships, and ensuring adherence to claims policies and procedures. This full-time position offers an opportunity for skilled professionals to excel in a dynamic environment.

Qualifications

• Matric or equivalent - essential.
• 5–8 years' experience in an insurance industry claims environment.
• Sound knowledge of claims policies, procedures, and processes.

Responsibilities

• Investigate the legitimacy of claims considering various data sources.
• Review case circumstances through research, interviews, and inspections.
• Identify and review claims for potential fraud attempts.
• Consult with experts for evaluations.
• Ensure accurate record keeping and reporting.

Skills

Claims investigation

Knowledge of Insurance Law

Client relationship management

Analytical skills

Education

Bachelor's Degree in Business/Management, Economics, Law, or Mathematics

Job description

Talent Pool: Claims Auditor MMH*********

Role Purpose

Investigate claims to determine legitimacy of claims and adherence to product and organisational requirements.

Location

Johannesburg Metropolitan Area

Employment Type

Full-time

Seniority Level

Mid-Senior level

Job Function

Finance and Sales

Requirements

• Matric or equivalent - essential
• Bachelor's Degree in Business/management, Economics, Law, Mathematics or related - desirable
• 5 – 8 years' experience in an insurance industry claims environment
• Sound knowledge of Claims policies, procedures and processes.
• Sound knowledge of business products, associated rules and legislation.
• Knowledge of Insurance Law.

Duties and Responsibilities

• Investigate the legitimacy of claims by considering various data sources such as background of claimants and witnesses, events surrounding the incident and the claim.
• Review the circumstances of the case through research, interviews, surveillance and in‑person inspections of sites and vehicles, writing reports on their findings.
• Identify and review claims in light of the circumstances of the claim and identify potential attempts of fraud.
• Conduct interviews with claimants and/or witnesses to gather and verify information to support the claims process.
• Investigate suspicious insurance claims, including those that are suspected to have stemmed from fraud, criminal activity, arson, falsified documents, or unnecessary medical procedures.
• Consult with various experts to get expert evaluations, as relevant.
• Ensure proper record keeping and reporting to ensure accurate record and evidence of investigations and findings.
• Provide findings to relevant stakeholders for determination.
• Act as expert witness in court cases if required.
• Provide authoritative expertise and advice to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders.
• Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service and fair treatment of clients within area of responsibility.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
• Develop and maintain productive and collaborative working relationships with peers and stakeholders.
• Positively influence and participate in change initiatives.
• Continuously develop own expertise in terms of professional, industry and legislation knowledge.
• Contribute to continuous innovation through the development, sharing and implementation of new ideas.
• Take ownership for driving career development.
• Contribute to the financial planning process within area.
• Identify opportunities to enhance cost effectiveness and increase operational efficiency.
• Manage financial and other company resources under your control with due respect.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forums.

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