Claims Investigator: Multi-skilled - Centurion at Momentum Metropolitan Holdings Limited

Role Purpose    

• To contribute to the organizational 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 of investigative experience in Personal and commercial claims environment

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
• Apply the policy to ensure the loss is covered in terms 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
• Irrespective of the outcome of the claim the broker, client, and claims advisor are to be notified (rejected claims are 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 finalize 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 the sale/policy wording and application or adjustment of underwriting criteria
• Report on any risks identified and suggested controls and report any other failures that influence 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 efficiency
• Interact with clients, brokers and service providers

Competencies    

• Analytical Thinking
• Information Seeking
• Directiveness
• Initiative
• Flexibility
• Client-centric