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  • Posted: May 16, 2022
    Deadline: Not specified
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    Momentum is a trusted partner on your journey to financial wellness. We guide you by offering leading advice, products and services. We are committed to helping you fulfill your lifelong financial needs, by providing relevant and unique solutions to suit your budget and individual circumstances. It is our aim to build and maintain enduring relationships by p...
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    Personal Lines Claims Investigator (KZN)

    Role Purpose    
    Momentum Insure is looking for 1 personal lines claims investigator to be based in the Kwa-Zulu Natal province. A claims investigator identifies and prevents fraudulent claims and manages the expenditure on settled claims.

    Requirements    

    • Matric
    • Minimum 3 years of investigative experience in a short-term personal claims environment
    • Completion of an investigations programme would be beneficial
    • FAIS accreditation or a FAIS recognised qualification will be highly beneficial
    • Clear criminal record
    • Above average performance track record

    Location

    • The above-mentioned position is currently available in the KwaZulu-Natal province and the successful candidate will be required to have their own mode of transport to be able to travel to clients.

    Duties & Responsibilities    

    • Receive personal 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 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 the sale/policy wording and application or adjustment of underwriting criteria
    • 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 efficiency
    • Interact with clients, brokers and service providers 

    Closing Date: 17th, May 2022

    Method of Application

    Interested and qualified? Go to Momentum on momentum.erecruit.co to apply

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