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.za
Role Purpose To contribute to the organisational goals by investigating, negotiating and administering claims. Identify and prevent fraudulent claims and manage expenditure on settled claims.
Requirements MatricFAIS accreditation or a FAIS recognised qualification will be highly beneficialMinimum experience of 3 years investigative experience in Personal and commercial claims environmentOwn reliable vehicle Duties & Responsibilities Receive personal and commercial 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 approvalIrrespective of the outcome of the claim the broker, client and claims advisor to be notified (rejected claims to be communicated verbally and in writing)The key focus of a claims investigator is to limit financial losses due to a policy/claim fraud and to finalise and adjust claims accurately obtain all evidence in a proper manner to ensure that it is admissible as evidence in a court of lawAct as complainant where fraud is found and render all assistance and evidence to ensure the 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 influences the merits of an investigationInternal Process:Enhance service delivery in the claims departmentsContribute to optimising work practices and procedures via suggestionsUp skill/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 scores, Ombudsman overturned ratios and expense ratiosPeople: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 relation/interact with support services to ensure effecienciesInteract with clients, brokers and service providers#J-18808-Ljbffr
