Specialist Investigator at Old Mutual South Africa

Detailed Description

• To continuously improve Special investigation Unit (SIU) service and contain expenses.
• Ensure effective specialised investigation of Claims to minimise fraud.
• Determining the merits of the claim - fraudulent versus legitimate.
• Report findings of investigation in an effective and unbiased manner.
• Conduct presentations on fraud awareness – Red Flags.
• Ensure the timeous identification, if possible, of fraudulent claims, resulting in monetary savings for the company.
• Ensure data is quality controlled.
• Effectively communicate and give feedback to clients, staff, and call center as required.
• Analyse query and complaints trends and suggest solutions.
• Prepare periodic reports and presentations on project progress, issues and progress against timeline reports/updates.Service delivery to ensure customer satisfaction
• Maintain service, quality and desired outputs within a specific functional process through ensuring compliance to tactical policies, procedures and standards.
• Resolve escalated customer queries and complaints and provide feedback to customers on matters resolved.
• Develop work routines in line with operational plans / schedules in order to manage achievement of service delivery goals
• Measure and monitor service delivery compliance of team.
• Share knowledge on, and participate in the creation of new standards, control systems and procedures to maintain service delivery.
• Share and transfer product, process and systems knowledge to colleagues.
• Collaborate and work with the Claims team to ensure required service levels are delivered.
• Actively participate in the Claims team to ensure functional balanced scorecard objectives are achieved.
• Actively share information with other team members regarding successes, issues, trends and ideas.
• Actively participate in own professional development and career path.
• Track and resolve operational and performance variations
• Develop and encourage strong team work
• Identify potential inter-departmental problems and escalate them to higher levels
• Engage regularly in team or group problem-solving
• Manage areas of critical compliance and actively manage non-conformance
• Actively manage non-performance
• Ensure the work environment enables employees to “live” the organisation culture and values. Ensure effective cost control and governance compliance
• Ensure adherence to financial and corporate policies and procedures, and reduce wastage related to area of accountability.
• Take accountability for the management of business related risks within own area.
• Operate within agreed mandates as documented in the business rules. Continuous improvement to ensure effective service
• Ensure adherence to organisational policies, practices and procedures.
• Identify and recommend areas / ways to improve processes.

Job Requirements

• Matric
• Minimum 3 years’ experience in a related field
• Extensive knowledge of Criminal Procedure Act (51 of 1977) i.e. gathering and chain of evidence in preparation of matters for court procedures
• Extensive knowledge of SA Criminal Law i.e. elements and definitions of applicable crimes
• Interpretation of policy wordings, conditions and application (preferable)
• Appropriate Insurance Qualification (Preferable)
• CFE Certificate would be an advantage.