Job description
Conduct thorough investigations of insurance claims, including reviewing documents, evidence, and supporting data. Verify the authenticity and accuracy of claims by analyzing medical records, financial information, and other relevant documents. Perform field investigations when necessary, including interviews with claimants, witnesses, agents, or related parties.
Identify potential fraud indicators and escalate suspicious cases for further action. Collaborate with internal teams (claims, underwriting, legal, and compliance) to ensure proper claim assessment. Prepare investigation reports with clear findings, conclusions, and recommendations. Maintain proper documentation and case records in line with company standards.
Support in developing and improving fraud detection Qualifications: Bachelor’s degree in Insurance, Law, Business, Finance, or a related field. Minimum 1–3 years of experience in claims handling, investigation, audit, or a related role (insurance industry preferred). Strong analytical and investigative skills. Knowledge of insurance claim processes, especially life or health insurance, is an advantage.