Specialised Claims Personal Lines Investigator MMH250618-3

Role Purpose

To identify and validate personal line claims to prevent fraud and contractual non -compliance including managing claims expenditure.

Requirements

Experience and Qualifications

• Matric or Equivalent
• 2- 3 years investigative experience in short term claims insurance
• Completion of an investigations programme would be beneficial. Eg. CFE, Criminal Law and forensic investigations
  
  

Additional Information

The above-mentioned position is currently available at our office in Centurion however a successful candidate will be required to travel to other regions from time to time.

Duties and Responsibilities

• Validates personal line claims identified for investigation through comprehensive assessment of the insurance contract, incident and items.
• Apply the policies terms and conditions to ensure the loss falls within the ambit of the contract.
• 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
• Communicate verbally and in writing the outcome of the claim to relevant stakeholder
• Ensure all evidence used to support/validate claims are legally admissible in a court of law.
• Report all cases of fraud and assist in collection of evidence to prosecute.
• Provide feedback to relevant stakeholders on findings and decisions that may impact the contract.
  
  

Internal Process

• Improve 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
  
  

As an applicant, please verify the legitimacy of this job advert on our company career page.-261893061