Personal Lines Claims Investigator - Pietermaritzburg
Our client operates in the market through multiple client-facing brands including insurance and investment brands.
Responsibilities and work outputs
• 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).
• Obtain all evidence in a proper manner to ensure that it is admissible as evidence in a court of law.
• 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.
Experience and Qualifications
• FAIS accreditation or a FAIS recognised qualification will be highly beneficial.
• Minimum experience of 3 years investigative experience in Personal claims environment.