Claims Investigator

**Who are we?**
- Job Description
- The Claims Investigator is responsible for conducting thorough investigations into insurance claims to detect potential fraud, validate the authenticity of claims, and ensure accurate and fair claims decisions. This includes fieldwork, interviews, desktop assessments, evidence gathering, and report compilation.
In addition to investigative excellence, the role requires a strong commitment to customer centricity—ensuring that all interactions
with policyholders, service providers, and stakeholders are handled with professionalism, empathy, and integrity. The investigator
must balance fraud risk management with the need for fair and respectful treatment of all customers.
- The on the road Investigator will conduct on-site investigations for non-motor insurance claims, gathering evidence, interviewing
witnesses, and assessing loss circumstances while compiling detailed factual reports with findings to support accurate claims
decisions and mitigate fraud risk.

**What will make you successful in this role?**

**Minimum Qualification Required**
- Grade 12 / National Senior Certificate (NQF Level 4)
- A valid driver's licence (Code B or higher)
- A relevant diploma or degree in Law, Insurance, Risk Management, Forensics or Criminology (advantageous)
- FAIS Regulatory Exam (RE5) - beneficial
- A forensic investigation certification (e.g. CFE) - advantageous

**Minimum Experience**
- 2 - 3 years of experience in short-term insurance claims investigations (non-motor, or commercial)
- Experience working with forensic tools, fraud indicators, and fraud detection techniques
- Previous exposure to legal processes, including criminal and civil matters - preferred
- Field investigations and interviewing experience - essential
- Proven ability to write investigative and factual reports

**Deliverables include, but will not be limited to**
- Conduct comprehensive investigations on claims flagged for potential fraud, misrepresentation, or irregularities.
- Review and analyse claim documentation, underwriting history, digital evidence, policy details, prior claims, and supporting records.
- Cross-reference information across internal systems (e.g., underwriting notes, CRM, claims systems) and external data sources (e.g., industry databases, social media, public records).
- Prepare clear, concise, and evidence-based investigation reports with appropriate findings and recommendations (e.g., support, repudiate, refer for field investigation).
- Liaise with internal stakeholders (Claims, Legal, Underwriting, Compliance) to guide decisions based on investigative outcomes.
- Identify emerging fraud patterns and contribute to fraud detection improvement initiatives.
- Maintain detailed, secure, and POPIA-compliant records of all investigations and correspondence.
- Escalate complex cases to field investigators or forensic units where physical inspection is required.
- Meet required SLAs, performance targets, and reporting timelines.

**Competencies Required**
- Strong analytical, interviewing, and report-writing skills.
- Knowledge of the short-term insurance regulatory and legal environment.
- Ability to handle conflict, work under pressure, and manage multiple cases concurrently.
- High levels of integrity, discretion, and professionalism.
- Proficient in MS Office and relevant digital investigation tools or platforms.
- Customer-centric with a strong sense of ethical responsibility and fairness

**Knowledge and Skills**
- Assessing and processing of claims
- Manage settlement of claims
- Reporting and Administration
- Basic Client engagements and consultations

**Personal Attributes**
- Interpersonal savvy - Contributing independently
- Decision quality - Contributing independently
- Action orientated - Contributing independently
- Optimises work processes - Contributing independently

**Build a successful career with us**
- We’re all about building strong, lasting relationships with our employees. We know that you have hopes for your future - your career, your personal development and of achieving great things. We pride ourselves in helping our employees to realise their worth. Through its five business clusters - Sanlam Fintech, Sanlam Life and Savings, Sanlam Investment Group, Sanlam Allianz, Santam, as well as MiWay and the Group Office - the group provides many opportunities for growth and development.

**Core Competencies**
- Cultivates innovation - Contributing independently
- Customer focus - Contributing independently
- Drives results - Contributing independently
- Collaborates - Contributing independently
- Being resilient - Contributing independently

**Turnaround time**

**Our commitment to transformation**

At MiWay we believe in cultivating a positive and dynamic working environment that gives you freedom and opportunity to succeed. MiWay is committed to transformation and embracing diversity. This is what drives us to achieve a multicultural workplace with employment equity as a