Desktop Investigator at Hollard Insurance

Role Objectives:

• To ensure that all claims referred to Claims Investigation are validated correctly by performing accurate and timeous confirmations with 3rd party individuals. Any fraudulent activities detected are to be referred to the Claims Investigation manager to validate and assign to a claim’s investigator for field investigation.

Key Responsibilities:

The key outputs required for the core function of financial crime investigation:

• Ensuring daily tasks and validation of claims are processed within the agreed service level agreement.
• Perform 3rd party verifications on all claims referred to confirm if the claim is valid/ fraudulent.
• Managing Hollard’s risk by ensuring that valid claims are paid and invalid claims are not paid.
• Managing our risk by verifying the information at sales, administration and claims stage and reporting operational risks to Compliance.
• To capture all claims referred on the Respond system for case tracking and reporting purposes.
• To perform related tasks within claims investigations as per the request of the Senior Manager and / or the Investigations Managers that support the overall objective of the claims team.
• Ensure compliance with all relevant legislation (FICA, POPIA, TCF).
• Ensure all standard claim documents are received with the required referral form for each investigation.
• Engage with fellow colleagues within the team on any ideas for continuous process improvement.
• Work closely with internal and external stakeholders.
• Assist with special projects from time to time when requested.

Required Knowledge and Experience    

• 4 – 5 years claims assessment experience
• Financial services experience, Long Term / Life Insurance specific
• Previous experience in desktop investigation highly advantageous
• Long Term / Life Insurance specific
• Basic knowledge of proceeds of Crime, Money Laundering, Corruption, Electronic Communications and Cyber Fraud and related legislation
• Financial Crime Risk Management
• Knowledge of syndicate and pattern of crime
• Report writing
• Communication skills (written and verbal)
• Presentation skills
• Attention to detail (ability to pick up / identify red flags and triggers)
• Computer literacy (Microsoft Office)
• Maintain high level of confidentiality when investigating claim fraud
• Conversant in diverse South African languages as advantage

Educational Requirements    

• Matric
• COP
• Business / Risk Management / Forensics / Audit Degree and / or equivalent tertiary qualification, relevant for this position will be an advantage