Job Description

Who are we?

At MiWay, our purpose is to enable people to live their way. We understand that life is not just about "things" but the meaning that those things bring to your life. We believe that technology and innovation have infinite possibilities when it's inspired by humans by you.

Therefore, we focus on our clients' needs; finding new ways to simplify their lives and how they do things.

We give them products, services, and solutions that enable them to live and enjoy life on their own terms - in their own way.

Agile values and principles are strongly embedded in our culture, and they are at the core of how we make decisions and how we approach adding value within the company.

Build a successful career with us

We're all about building strong, lasting relationships with our employees. We know that you have hopes for your future - your career, your personal development and of achieving great things. We pride ourselves in helping our employees to realise their worth. Through its five business clusters - Sanlam Fintech, Sanlam Life and Savings, Sanlam Investment Group, Sanlam Allianz, Santam, as well as MiWay and the Group Office - the group provides many opportunities for growth and development.

What will you do?

The Claims Investigator is responsible for conducting thorough investigations into insurance claims to detect potential fraud,

validate the authenticity of claims, and ensure accurate and fair claims decisions. This includes fieldwork, interviews, desktop assessments, evidence gathering, and report compilation.

In addition to investigative excellence, the role requires a strong commitment to customer centricity--ensuring that all interactions with policyholders, service providers, and stakeholders are handled with professionalism, empathy, and integrity. The investigator must balance fraud risk management with the need for fair and respectful treatment of all customers.

Minimum requirements for his role:

Minimum Qualification Required

Grade 12 / National Senior Certificate (NQF Level 4) A valid driver's licence (Code B or higher) A relevant diploma or degree in Law, Insurance, Risk Management, Forensics or Criminology (advantageous) FAIS Regulatory Exam (RE5) - beneficial A forensic investigation certification (e.g. CFE) - advantageous

Minimum Experience

2 - 3 years of experience in short-term insurance claims investigations (motor, non-motor, or commercial) Experience working with forensic tools, fraud indicators, and fraud detection techniques Previous exposure to legal processes, including criminal and civil matters - preferred Field investigations and interviewing experience - essential Proven ability to write investigative and factual reports Deliverables include, but will not be limited to
Conduct comprehensive investigations on claims flagged for potential fraud, misrepresentation,
or irregularities.
Review and analyse claim documentation, underwriting history, digital evidence, policy details, prior
claims, and supporting records.
Conduct telephonic interviews with claimants, witnesses, and service providers, applying
professional and probing techniques.
Cross-reference information across internal systems (e.g., underwriting notes, CRM, claims systems)
and external data sources (e.g., industry databases, social media, public records).
Prepare clear, concise, and evidence-based investigation reports with appropriate findings and
recommendations (e.g., support, repudiate, refer for field investigation).
Liaise with internal stakeholders (Claims, Legal, Underwriting, Compliance) to guide decisions based
on investigative outcomes.
Identify emerging fraud patterns and contribute to fraud detection improvement initiatives. Maintain detailed, secure, and POPIA-compliant records of all investigations and correspondence. Escalate complex cases to field investigators or forensic units where physical inspection is required. Meet required SLAs, performance targets, and reporting timelines. Strong analytical, interviewing, and report-writing skills. Knowledge of the short-term insurance regulatory and legal environment. Ability to handle conflict, work under pressure, and manage multiple cases concurrently. High levels of integrity, discretion, and professionalism. Proficient in MS Office and relevant digital investigation tools or platforms. Customer-centric with a strong sense of ethical responsibility and fairness

Knowledge and Skills

Automotive Damage Claims
Claims Management
Claims Reporting
Claims approvals and rejections
Claims settlements

Personal Attributes

Interpersonal savvy - Contributing independently
Decision quality - Contributing independently
Action orientated - Contributing independently
Optimises work processes - Contributing independently

Core Competencies

Cultivates innovation - Contributing independently
Customer focus - Contributing independently
Drives results - Contributing independently
Collaborates - Contributing independently
Being resilient - Contributing independently

Turnaround time

The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of managers.

Our commitment to transformation

At MiWay we believe in cultivating a positive and dynamic working environment that gives you freedom and opportunity to succeed. MiWay is committed to transformation and embracing diversity. This is what drives us to achieve a multicultural workplace with employment equity as a key goal to create an inclusive workforce, reflective of the demographics of our society.