Personal Lines Claims Investigator

5 months ago


Durban, South Africa Momentum Insure Company Limited Full time

**Introduction**
- Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme),and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations.

**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.**Role Purpose**
- Momentum Insure is looking for 1 personal lines claims investigator. A claims investigator identifies and prevents fraudulent claims and manages the expenditure on settled claims.**Requirements**:

- Matric
- Minimum 3 years investigative experience in a short-term personal claims environment
- Completion of an investigations programme would be beneficial
- FAIS accreditation or a FAIS recognised qualification will be highly beneficial

**Duties & Responsibilities**
- Receive personal 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 efficiency
- Interact with clients, brokers and service providers

**Competencies**
- Analytical Thinking
- Information Seeking
- Directiveness
- Initiative
- Flexibility
- Client centric



  • Durban, South Africa Momentum Metropolitan Holdings Full time

    -Introduction Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. Role Purpose Momentum Insure is looking...


  • Durban, South Africa Santam Full time

    CAREER OPPORTUNITY Santam’s Merit Claims department has positions available for a Motor Merit Field Investigator based in Auckland Park, Gauteng. The Merit Field Investigator will ensure that all flagged and segmented claims are comprehensively investigated to achieve conclusive results. The successful incumbent will maintain credibility by ensuring that...


  • Durban, South Africa Santam Full time

    OPPORTUNITY Santam’s Merit Claims department has positions available for a Motor Merit Field Investigator based in 06 The Terrance, West Way, Office Park, Westville, 4001 WHAT WILL YOU DO The Merit Field Investigator will ensure that all flagged and segmented claims are comprehensively investigated to achieve conclusive results. The successful incumbent...


  • Durban, South Africa OUTsurance Full time

    Company Description OUTsurance is a customer-centric financial services company with a global foot print. We are vibrant, successful and values orientated with an awesome dynamic culture encapsulated by the ethos that clients and staff “always get something OUT.” Our success can be attributed, amongst other things, to the outstanding people that work...


  • Durban, South Africa Nedbank Full time

    **Talent Acquisition Consultant **Ayanda Tshabalala - Req ID 116041 Location Johannesburg FAIS Affected FAIS Affected - Yes **Job Purpose** To provide claims administration support in respect of Long-term insurance matters to stakeholders in line with Nedbank strategy. **Responsibilities**: - Assess and make decisions on General claims (Death,...


  • Durban, South Africa OUTsurance Full time

    Company Description OUTsurance is a customer-centric financial services company with a global foot print. We are vibrant, successful and values orientated with an awesome dynamic culture encapsulated by the ethos that clients and staff “always get something OUT.” Our success can be attributed, amongst other things, to the outstanding people that work for...

  • Claims Assessor

    1 week ago


    Durban, South Africa Discovery Ltd. Full time

    **Business Unit**:Discovery Insure **Function**:Claims Administration **Date**:6 Jan 2025 **Key Purpose** - To investigate and validate non-motor claims to determine validity based on the Discovery Insure contract. To correctly quantify and validate losses and serve as a mediator between clients and/or brokers. Provide feedback and support to claims...


  • Durban, South Africa OUTsurance Full time

    **Company Description** OUTsurance has been propelling the South African insurance industry forward for the last 26 years. As leaders in the field, we’re always looking for innovative ways to create digitally-advanced solutions, without losing sight of our human values. Our continued success can be attributed to outstanding employees who set the bar high...


  • Durban, South Africa Unilever Full time

    Job Title: Pricing Claims Specialist Reports to: Promo & Pricing Lead Function / Sub-Function: Customer Operations / Order To Cash Work Level: WL1C Location: La Lucia Background: iOps is focused on transforming the way we work to create exceptional experiences across Unilever’s wider ecosystem encompassing markets, customers and Partners. Through...


  • Durban, South Africa DELLA MARTINA RECRUITING Full time

    Leading National Financial Institution has a vacancy for a SENIOR CLAIMS CONSULTANT for their SHORT TERM INSURANCE DIVISION in the heart of Durban. **Description of Role**: To provide clients with an efficient and effective claims service and support in respect of their claims. **Key Responsibilities**: - The registration and maintenance of all motor and...

  • Forensic Investigator

    2 weeks ago


    Durban, South Africa Momentum Metropolitan Holdings Full time

    -Introduction Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. Role Purpose Investigate white collar...

  • Forensic Investigator

    7 months ago


    Durban, South Africa Risk Management Full time

    **Introduction** Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings,...


  • Durban, South Africa Bidvest International Logistics Full time

    **Job Purpose**: **Qualifications & Experience**: - LLB degree - Shipping / marine law or insurance diploma / certificate - At least two years corporate legal or insurance experience - Previous work experience in a logistics or freight environment preferable **Key Responsibilities**: **Claims** - Assist with the overall administration of insurance claims,...

  • Forensic Investigator

    7 months ago


    Durban, South Africa Risk Management Full time

    **Introduction** - Are you passionate about fighting financial crime and ensuring the integrity of financial systems? Join our elite Group Forensic Services and Anti-Money Laundering Operations team, where your skills and dedication will play a pivotal role in maintaining a zero-tolerance stance against commercial crime and money laundering. Collaborate with...


  • Durban, South Africa DELLA MARTINA RECRUITING Full time

    **Well established, National Financial Institution has a vacancy for a PERSONAL LINES UNDERWRITING ADMINISTRATOR in Durban.** **KEY RESPONSIBILITIES**: Full Underwriting Function: - Renewals - Endorsements - Policy Wordings - Client Liaison **Insurance Knowledge** - Studying various insurance products and proposals, and gathering and assessing background...


  • Durban, South Africa Pronel Personnel Full time

    **Job Purpose** **A. Claims Processing** The following directly centers around your daily obligations: - Authorise claims within the set mandate and resolve all claims within the agreed productivity targets and turnaround times by utilising the claims diary system effectively. - Demonstrate a clear understanding and execution of customer complaints and...


  • Durban, South Africa The Recruiters Full time

    **Title**: **Personal Lines Underwriter**: **Salary**: - R15 000 - R30 000 **Description**: - Our client is a market leading short term insurance broker with over a quarter-century of experience. They provide insurance services to people and businesses across South Africa. They are a fully independent financial services provider that only underwrites...

  • Eft Claims Specialist

    7 months ago


    Durban, South Africa Unilever Full time

    Job Title: EFT Specialist Reports to: EFT Lead Function / Sub-Function: Customer Operations / Order To Cash Work Level: WL1C Location: La Lucia Background: iOps is focused on transforming the way we work to create exceptional experiences across Unilever’s wider ecosystem encompassing markets, customers and Partners. Through leveraging connected...


  • Durban, KwaZulu-Natal, South Africa The Recruitment Council Full time

    About the Role:The Recruitment Council seeks a Personal Lines Development Manager to join our team. As a key member of our sales team, you will be responsible for growing our personal lines business by converting company-provided leads into new business opportunities. You will focus on client acquisition and account management without cold...


  • Durban North, South Africa HVM Full time

    **Job purpose/mandate** A well-established, Durban North-based entity seeks Administrator. **Specific duties and responsibilities** *Short-Term Insurance Underwriting Administration and Claims Administration. *Must have comprehensive knowledge of Personal Lines and Commercial Lines products. - Administration Role includes: - Broker Assistant - Servicing...