Multi-skilled Claims Investigator

2 weeks 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),-
**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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