Multi-skilled Claims Investigator

2 weeks ago


Centurion, South Africa Momentum Insure Company Limited Full time

**Introduction**

**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

**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
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
- 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**
- Comminicate effectivetly
- Attetion to detail
- Team player
- Analytical thinking
- Work independently


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