Internal Investigator at Trident Insurance Company

REPORTS TO    CLAIMS MANAGER
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 claimsthat may be fraudulent.
• Compile investigation reports after collecting data from the field visits within the laid down
• timelines andhand 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 claimsbeing reported to collect salient photographic evidence of the scene to ascertain the extent of damage caused to the client’s vehicleand any otherTPPD 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 periodicalclaims 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 director indirectcontact 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 establishedby 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  5  years’  work  experience  preferably  in  a  reputable  Investigator  firm  or Insurance Company