Multi-skilled Claims Investigator

2 weeks ago


Durban, KwaZulu-Natal, South Africa Momentum Insure Company Limited Full time

Introduction

  • Through our clientfacing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme),
    Role Purpose
  • To contribute to the organisational goals by investigating, negotiating and administering claims. Identify and prevent fraudulent claims and manage expenditure on settled claims.

Requirements:

  • Matric
  • FAIS accreditation or a FAIS recognised qualification will be highly beneficial
  • Minimum experience of 3 years investigative experience in Personal and commercial claims environment
  • Own reliable vehicle

Duties & Responsibilities

  • Receive personal and commercial line claims identified by the fraud prediction model for validation
  • Confirm merits of each claim through comprehensive assessment of the item and incident
  • Compile a comprehensive report on all findings and make a recommendation on a claim based on
merits/evidence found during the validation process

  • Refer all recommendations not within your mandate to the line manager for approval
  • Irrespective of the outcome of the claim the broker, client and claims advisor to be notified (rejected claims
to be communicated verbally and in writing)

  • The key focus of a claims investigator is to limit financial losses due to a policy/claim fraud and to finalise
and adjust claims accurately obtain all evidence in a proper manner to ensure that it is admissible as evidence in a
court of law

  • Act as complainant where fraud is found and render all assistance and evidence to ensure the prosecution
of the person who committed/attempted to commit fraud

  • Assist/influence other areas of the business once an investigation is concluded, i.e. report on the quality of
  • Report on any risks identified and suggested controls and report any other failures which influences the
merits of an investigation

Internal Process:

  • Enhance service delivery in the claims departments
  • Contribute to optimising work practices and procedures via suggestions
  • Up skill/influence claims advisors by sharing knowledge
  • Effectively build, maintain and manage relationships with clients, brokers, service providers and business
partners

  • Ensure investigations are done in a professional manner and all parties are updated regularly on the
progress

  • Achieve minimum standards with regards to saving ratios, turnaround time, Customer Satisfaction scores,
Ombudsman overturned ratios and expense ratios

People:

  • Live the Momentum values
  • Interact with colleagues and supply manager investigation results
  • Interact with other business units i.e. claims, client services, brokers, compliance, legal etc.
  • Build relation/interact with support services to ensure effeciencies
  • Interact with clients, brokers and service providers

Competencies

  • Attention to detail
  • Critical thinking
  • Analytical Skills
  • Time management
  • Interpersonal skills


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