Claims Investigator (WC)

Investigations

• Plan and conduct claims investigations in accordance with standard operating procedures applicable legislation and industry best practice.
• Investigate allegations of fraud theft and other improper conduct relating to claims.
• Participate in internal and external investigations on a case-by-case basis.
• Gather verify analyse and evaluate relevant information documentation and supporting evidence.
• Obtain statements from relevant stakeholders and individuals associated with investigations.
• Conduct interviews in a professional objective and appropriate manner.
• Ensure investigations are comprehensive objective and completed within agreed turnaround times.

Investigation Reports and Case Management

• Prepare comprehensive investigation reports detailing facts findings conclusions and recommendations.
• Ensure investigation reports adhere to applicable professional standards including relevant ACFE and/or ICFP standards.
• Collate and compile relevant documentation and evidence into complete investigation case files.
• Prepare case files for potential criminal civil internal or external proceedings.
• Ensure evidence is accurately documented appropriately secured and traceable.
• Maintain accurate complete and up-to-date investigation records and filing systems.

Fraud Prevention and Loss Recovery

• Identify trends risks and indicators associated with fraudulent activities.
• Contribute to initiatives aimed at preventing and minimising fraud-related activities and financial losses.
• Assist with the recovery of losses arising from fraudulent or improper activities.
• Escalate material findings risks and concerns in accordance with established procedures.

Stakeholder and Customer Management

• Liaise effectively with relevant internal departments and external stakeholders throughout the investigation process.
• Liaise with law enforcement agencies and other relevant organisations where required.
• Communicate investigation findings and relevant information to appropriate stakeholders.
• Handle claim-related queries within agreed service levels.
• Engage with customers professionally effectively and fairly in line with the principles of Treating Customers Fairly (TCF).

Compliance and Administration

• Ensure investigations are conducted in accordance with applicable legislation company policies and procedures.
• Maintain the highest standards of confidentiality professionalism integrity and ethical conduct.
• Update relevant systems throughout the investigation lifecycle.
• Maintain accurate records of investigation activities outcomes and supporting documentation.
• Ensure completed investigations are finalised within agreed turnaround times.
• Maintain organised and auditable investigation files

Minimum 5 years experience in an investigative role.

Minimum 3 years experience within a financial services insurance forensic or related environment.

Experience conducting fraud and/or claims investigations will be advantageous.

Experience preparing formal investigation reports.

Experience providing testimony or presenting evidence will be advantageous.