Job Description

Closing Date 2025/12/26
Reference Number MMH251128-20
Job Title Talent Pool: Claims Auditor
Position Type Permanent
Cluster Momentum Health
Remote Opportunity None of the time
Location - Country South Africa
Location - Province Gauteng
Location - Town / City Sandton
Introduction
Through our client-facing brands Momentum Group, 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.
Role Purpose
Investigate claims to determine legitimacy of claims and adherence to product and organisational requirements.
Requirements

• Matric or equivalent - essential
• Bachelor's Degree in Business/management, Economics, Law, Mathematics or related - desirable
• 5 - 8 years' experience in an insurance industry claims environment
• Sound knowledge of Claims policies, procedures and processes.
• Sound knowledge of business products, associated rules and legislation.
• Knowledge of Insurance Law.

Duties & Responsibilities
INTERNAL PROCESS

• Investigate the legitimacy of claims by considering various data sources such as background of claimants and witnesses, events surrounding the incident and the claim.
• Review the circumstances of the case through research, interviews, surveillance and in-person inspections of sites and vehicles, writing reports on their findings.
• Identify and review claims in light of the circumstances of the claim and identify potential attempts of fraud.
• Conduct interviews with claimants and/or witnesses to gather and verify information to support the claims process.
• Investigate suspicious insurance claims, including those that are suspected to have stemmed from fraud, criminal activity, arson, falsified documents, or unnecessary medical procedures.
• Consult with various experts to get expert evaluations, as relevant.
• Ensure proper record keeping and reporting to ensure accurate record and evidence of investigations and findings.
• Provide findings to relevant stakeholders for determination.
• Act as expert witness in court cases if required.

CLIENT

• Provide authoritative, expertise and advice to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders.
• Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service and fair treatment of clients within area of responsibility.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

PEOPLE

• Develop and maintain productive and collaborative working relationships with peers and stakeholders
• Positively influence and participate in change initiatives
• Continuously develop own expertise in terms of professional, industry and legislation knowledge
• Contribute to continuous innovation through the development, sharing and implementation of new ideas
• Take ownership for driving career development

FINANCE

• Contribute to the financial planning process within area
• Identify opportunities to enhance cost effectiveness and increase operational efficiency
• Manage financial and other company resources under your control with due respect
• Provide input into the risk identification processes and communicate recommendations in the appropriate forums.

Competencies

• Written and verbal communication
• Problem solving
• Influence
• Presentation
• Critical thinking
• Detail-oriented
• Results focused
• Collaboration and teamwork
• Resilience
• Planning
• Time management skills
• Numeracy skills

Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

Skills Required