Specialized Claims Investigator - Western Cape

Introduction Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities and businesses. Visit us at www.momentummetropolitan.co.za

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

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

Requirements

• 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.

Duties & 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

Competencies

• Analytical skills

• Time management

• Report writing

• Communication skills (Internal and External stakeholders)

• Innovation

• Client Centric

• Results Driven

• Collaboration

• Resilient