We Are Looking For Claim Investigator For Insurance Claim

Negotiable

by Freshersworld
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Job Specifications

Employment Type Full time jobs

Job Description

We are looking for Claim Investigator for insurance claim. Candidate must be smart to handle field work. Good communication skills. Willing to move various places for investigation. Time oriented and punctual to his job. Report properly of the case.&

Key Responsibilities:

Investigation of Claims:
- Conduct thorough investigations of insurance claims, including health, life, motor, property, or general insurance cases.
- Identify red flags or irregularities in claims that may indicate misrepresentation, fraud, or exaggeration.
- Analyze supporting documents such as medical records, police reports, invoices, repair estimates, and eyewitness accounts.
Field Visits and Surveillance:
- Visit accident sites, hospitals, homes, or other relevant locations to gather facts and evidence.
- Interview claimants, witnesses, medical professionals, law enforcement, and other stakeholders to collect testimony and clarification.
- Conduct discreet surveillance if required and allowed by law, to verify the legitimacy of the claim.
Evidence Collection and Documentation:
- Take photographs, video recordings, or physical evidence as needed to support findings.
- Maintain detailed case notes, timelines, and reports throughout the investigation process.
- Collect and verify legal documents, identity proofs, death certificates, bills, and receipts as applicable.
Report Preparation:
- Prepare comprehensive investigation reports summarizing findings, with documented evidence and conclusions.
- Make recommendations regarding claim approval, denial, or further action based on investigation results.
- Present findings to claims adjusters, legal teams, or senior management for final decision-making.
Collaboration with Teams and Agencies:
- Work closely with claim processing teams, underwriters, legal teams, and customer service departments.
- Liaise with police departments, government offices, hospitals, and private investigators for information verification.
- Coordinate with third-party investigation firms or forensic specialists when needed.
Fraud Detection and Prevention:
- Identify trends and patterns in fraudulent behavior to proactively flag suspicious claims.
- Recommend improvements in internal claim screening procedures to reduce fraud risk.
- Assist in the development and updating of fraud detection tools or software models.
Legal and Compliance Adherence:
- Ensure that all investigations are conducted within legal boundaries and industry regulations.
- Follow company protocols, insurance laws, privacy policies, and data protection standards.
- Testify in court or arbitration panels if required, as an expert or factual witness.

Job Profile : We are looking for Claim Investigator for insurance claim
Industry : sales-and-marketing

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About Employer

Freshersworld (Registered since June-2017)

Sb Management

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