Insurance companies hire claims investigators to prevent losses from fraudulent claims. Investigators review cases, conduct background searches, and may conduct surveillance to find evidence of fraud. Education and state licensing may be required, and a well-trained mind with a knack for logic and organization is essential.
Were it not for the fact that insurance fraud occurs, insurance companies would not need claims investigators. Unfortunately, there are many different types of insurance fraud and false claims, and insurance companies can lose a lot of money if they only pay claims they find dubious. To avoid this loss, many insurance companies are staffed or contracted with at least one claims investigator so that they can attempt to pay only legitimate claims.
Generally, claims investigator help is sought when a company suspects fraud. Suspicion may arise during the first few examinations of a claim, which may be performed by insurance examiners or adjusters. The investigator will review the case, reviewing all information provided by the company and the complainants. He or she may also investigate applicants to some extent to find out whether they have information in the past that might suggest fraudulent behavior in the present. Criminal background searches may be conducted, the investigator may look for collusion between claimants and witnesses, and may also re-interview anyone involved in the claim.
In some cases, the insurance claims investigator not only looks at witness/claimant details, but may be out of bounds. He may need to conduct surveillance or survey the scene of an accident. The job can vary between actively and passively searching for evidence of insurance fraud.
There may be special requirements for becoming an insurance claims investigator. Some people move from private investigation or police work into this field. Others may study criminal justice at the college level, most often earning a bachelor’s degree before entering this field. Familiarity with state insurance laws is also vital, and any good investigator will need to know the common ways people try to commit insurance fraud.
Another one of the requirements to become an insurance investigator may be state licensing. In some states, investigators must be licensed as private investigators. This can vary, and individuals should review their state or country laws to determine specific requirements.
In addition to requiring some education and knowledge, any insurance claims investigator needs a well-trained mind: one that can spot fraud easily, see patterns in the collected information, and look for ways to prove suspicions. People who like this field like logic, reasoning and puzzles and are not afraid to do active detection work when needed. A high degree of organization may also be required, as sifting through all the paperwork and evidence gathered is more difficult when the organization is haphazard.
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