CIaims Investigator at Rand Mutual - RMA

Job description

Purpose

Reporting to the General Manager Claims, the incumbent will be responsible for interviewing claimants and witnesses, obtain oral and written statements, and take photographs for evidence. He or She will also safeguard documents and verify public and private records.
This person will be investigating: Compensation for Occupational Injuries Claims and claims relating to other Personal Accident and Life Insurance Products as well as verify bodily injuries and medical issues.

Qualifications and Experience Required:

• Grade 12
• Bachelor’s degree in Criminal Justice or Forensic Auditing or related
• Computer literacy with report writing skills
• Multilingual
• Good communication skills, verbal and written
• Ability to work under pressure
• Experience as a law enforcement, criminal justice professional, police officer, forensic laboratory technician or industry claims investigator
• Experience in Forensic Computer analytics will be an advantage

Key Areas of Responsibility:

• Investigate suspicious claims, including those that are suspected to have stemmed from fraud, criminal activity, arson, falsified documents, or unnecessary medical procedures
• Assess the correctness of the claimants’ statements and therefore determine the level of liability for each claim.
• This person should be skilled and experienced to investigate the validity of claims by gathering accident details and verify beneficiaries’ details.
• The investigator’s work environment varies greatly in that some days may be spent traveling, while others are spent in an office preparing reports
• Required to conduct investigations when the claim is a result of road accidents
• Visit the accident scene and investigate the circumstances
• Consult police and hospital records
• Assessing a range of factual information including claimants background
• Checking details with policy holders (Employers ), witnesses and other professionals (e.g. police )
• Writing reports and collating information
• Visit claimants to obtain oral statements
• Testify in court cases when claimant is accused of fraud

Knowledge, Skills and Competencies:

• Applied Learning
• Contributing to Team Success
• Managing Work (Includes Time Management)
• Initiating Action
• Stress Tolerance
• Decision Making