PURPOSE OF THE POSITION

• The Internal Investigator shall be responsible for conducting objective, fair, thorough, unbiased and timely investigations into allegations/suspicions of fraud committed by policyholders against the Organization as instructed by the claims-handling team.
• Record detailed statements from involved parties and relevant witnesses in efforts to sieve through cases requiring further investigations by an external investigator.
• Professionally and forensically, gather evidence to be used to support claims that may be fraudulent.
• Compile investigation reports after collecting data from the field visits within the laid down timelines and hand over the file to the claims team with recommendations.

KEY TASKS, DUTIES AND RESPONSIBILITIES

• Timely response and visit to risk address/scene of the accident for claims being reported to collect salient photographic evidence of the scene to ascertain the extent of damage caused to the client’s vehicle and any other TPPD that may have been involved.
• Analyze all investigation reports (both internal & external) to ensure that they are objective based on material facts admissible by the regulator and in a court of Law.
• Acts as liaison between corporate and appointed external investigators/loss adjusters to facilitate the gathering of information that will allow proper response to claim losses.
• Investigate, evaluate and advise on settlement of claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases to contribute to a sustainable loss ratio.
• Prepare periodical claims report and other management reports relating to claims and ensure that any necessary remedial action is taken promptly.
• Ensure in-depth investigation of claims through direct or indirect contact with policyholders, claimants, physicians, contractors and advocates ensuring that any detected fraud case is handled as per company policy guidelines.
• Review and analyze claims loss and expense reserves established by insurance carriers.

REQUIREMENTS

• Bachelor’s Degree/Diploma in Criminology, Forensic and Criminal Investigations, from a reputable institution of Higher education.
• Certificate of Insurance – Fraud Investigator
• At least 4 years’ work experience preferably in a reputable Investigator firm or Insurance Company