Are you inquisitive, analytical, detail-oriented? Can you tell when something is not quite right?
What do they do?
Fraud Investigators are brought in when further analysis is needed on claims that don’t seem quite right. They obtain evidence, take statements, and verify and analyze information to ensure that insurance claims – whether property and casualty or life, health, auto and more – are valid. They may also assist with the implementation and execution of fraud detection and prevention programs.
Why is it important?
Insurance fraud is a crime in all 50 states but nonetheless poses a significant problem, as fraudulent claims cost insurance companies billions of dollars each year and contribute to an increase in overall premiums. The number of claims filed each year – even each day – is staggering, making it impossible for insurance companies to individually check each one for fraud. However, existing efforts include computerized statistical analysis and referrals from Claims Adjusters, Agents and others when claims appear to be fraudulent.
- Conduct in-depth investigations of suspected internal or external fraud
- Obtain, review and prepare evidence, often for testimony in court
- Testify in court regarding investigation findings
- Interview witnesses or suspects and take statements
- Advise businesses or agencies on ways to improve fraud detection
- Create and maintain logs, records, or databases of information about fraudulent activity
- Coordinate investigative efforts with law enforcement officers and attorneys
- Complex Problem Solving
- Good Judgment and Decision Making
- Time Management
Education and Professional Requirements:
- Entry-level: Bachelor’s degree or equivalent law enforcement or claims experience
- Advancement: Bachelor’s degree, many years related work experience
Possible career path: Fraud Examiner > Senior Examiner > Manager, Special Investigations Unit
- OII Fraud Investigator Profile
- InVEST Fraud Investigator Profile
- IIC Fraud Investigator Profile
- NAPSLO Loss Control Overview
- IMUA Claims Overview
- US Bureau of Labor Statistics Occupational Outlook Handbook
- Meet a Fraud Investigator
- Inland Marine Underwriters Association Career Path Video
- NAPSLO Career Video
- International Association of Special Investigation Units: Certified Insurance Fraud Investigator (CIFI)