Investigator: Claims and Fraud

1 week ago

Cape Town, Western Cape, South Africa Road Accident Fund Full time

Discover a rewarding career with the Road Accident Fund as an Investigator: Claims and Fraud. In this challenging role, you will be responsible for conducting thorough investigations into claims lodged with the RAF.

Key Responsibilities:
  • Claims Investigation: You will investigate claims lodged with the RAF, tracing insured drivers and witnesses to consult and obtain statements and dockets.
  • Accident Scene Analysis: You will ensure that a proper sketch plan of the accident scene is drawn as part of the investigation and assessment process.
  • Photographic Evidence: You will take clear photographs of the accident scene, faces of people interviewed, damaged vehicles, and injuries to individuals.
  • Affidavits and Documents: You will obtain and verify existing affidavits from different parties, including claimants, witnesses, employers, and others.
  • Fraud Detection: You will identify possible fraud and corruption and escalate it to the Forensic Investigation Department (FID).
  • Court Testimony: You will testify in court cases when claimants are guilty and accused of fraud.
Administrative Support:
  • Document Validation: You will validate supporting documents, such as employment details, paternity/maternity details, SARS documents, and others.
  • ID Verification: You will verify details of claimants and those injured in accidents through Natis and Cross Check systems.
  • Vehicle Verification: You will verify details of secondary vehicles involved in accidents to determine owners.
  • Quality Control: You will quality-check supporting documents from stakeholders to determine validity of logged claims.
  • Loss of Earnings: You will validate loss of earnings.
  • Progress Reports: You will provide progress reports as per internal service level agreement.
Document and Records Management:
  • Filing System: You will monitor and maintain an effective filing system.
  • File Categorization: You will ensure that files are correctly categorized and stored for smooth retrieval of documents.
  • Records Administration: You will administer records management and filing processes in line with the RAF filing plan.
  • Confidentiality: You will ensure confidentiality of all documents under your control and that correspondence reaches intended recipients.
  • File Retrieval: You will perform file retrieval in Archive Services.
Stakeholder Management:
  • Advice Provision: You will provide advice to different parties, including claimants, witnesses, employers, and others.
  • Complaint Handling: You will handle assessments associated complaints.
  • Relationship Maintenance: You will maintain relationships with internal and external stakeholders.
Requirements:
  • Qualifications: You will require a related qualification at NQF 7 level (Bachelor's Degree/Advanced Diploma) or equivalent.
  • Driver's License: You will need a valid driver's license.
  • Investigation Training: Completed training as an investigator will be an added advantage.
  • Fraud Examination: Being a certified fraud examiner will be an added advantage.
  • Experience: You will require relevant 3 years' experience in a similar environment.
  • Insurance Knowledge: Experience in merit and quantum investigations will be an added advantage.

The estimated salary for this position is R450,000 - R600,000 per annum, depending on experience.

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