Closing Date: 2024/09/06Reference Number: MMH240827-4Job Title: Personal Lines Claims Investigator (KZN)Position Type: PermanentRole Family: Client ServicesCluster: Momentum Insure Company LimitedRemote Opportunity: Some of the timeLocation - Country: South AfricaLocation - Province: KwaZulu-NatalLocation - Town / City: DurbanIntroduction:Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms, Momentum Metropolitan provides practical financial solutions for people, communities and businesses. Visit us at www.momentummetropolitan.co.zaDisclaimer: As an applicant, please verify the legitimacy of this job advert on our company career page.Role Purpose:Momentum Insure is looking for 1 Personal Lines Claims Investigator. A claims investigator identifies and prevents fraudulent claims and manages the expenditure on settled claims.Requirements:MatricMinimum 3 years investigative experience in a short-term personal claims environmentCompletion of an investigations programme would be beneficialFAIS accreditation or a FAIS recognised qualification will be highly beneficialDuties & Responsibilities:Receive personal line claims identified by the fraud prediction model for validationConfirm merits of each claim through comprehensive assessment of the item and incidentApply the policy to ensure the loss is covered in terms of the contractCompile a comprehensive report on all findings and make a recommendation on a claim based on merits/evidence found during the validation processRefer all recommendations not within your mandate to the line manager for approvalNotify the broker, client, and claims advisor of outcomes, including rejected claims (to be communicated verbally and in writing)Limit financial losses due to policy/claim fraud and finalise and adjust claims accuratelyObtain all evidence in a proper manner to ensure admissibility as evidence in a court of lawAct as complainant where fraud is found and render all assistance and evidence to ensure prosecution of the person who committed/attempted to commit fraudAssist/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 criteriaReport on any risks identified and suggested controls and report any other failures which influence the investigation processMerits Of An Investigation Internal Process:Enhance service delivery in the claims departmentsContribute to optimising work practices and procedures via suggestionsUpskill/influence claims advisors by sharing knowledgeEffectively build, maintain and manage relationships with clients, brokers, service providers, and business partnersEnsure investigations are done in a professional manner and all parties are updated regularly on the progressAchieve minimum standards with regards to saving ratios, turnaround time, Customer Satisfaction scoresOmbudsman Overturned Ratios And Expense Ratios:Live the Momentum valuesInteract with colleagues and supply manager investigation resultsInteract with other business units i.e. claims, client services, brokers, compliance, legal etc.Build relationships/interact with support services to ensure efficiencyInteract with clients, brokers, and service providersCompetencies:Analytical ThinkingInformation SeekingDirectivenessInitiativeFlexibilityClient-centric
#J-18808-Ljbffr
