What is an Insurance Claims Investigator?

Were it not for the fact that insurance fraud occurs, insurance companies wouldn’t need insurance claims investigators. Unfortunately, there are many different types of insurance scams and false claims, and insurance companies may lose lots of money if they merely pay out on claims they think may be dubious. To avoid this loss, many insurance companies have on their staff or contract with at least one insurance claims investigator so they can attempt to only pay legitimate claims.

Usually, the help of the insurance claims investigator is solicited when a company suspects fraud. Suspicion may occur during the first few examinations of a claim, which may be conducted by insurance examiners or insurance adjusters. The investigator will review the case, going over all information provided by the company and claimants. He or she also may investigate the claimants to a certain degree to find out if they have information in their past that might suggest fraudulent behavior in the present. Searches for criminal records might be conducted, the investigator could look for collusion between claimants and witnesses, and he might also re-interview anyone involved in the claim.

In some instances the insurance claims investigator doesn’t just sift through witness/claimant details, but might be out in the field. He might need to perform surveillance or examine the scene of an accident. The job may vary between active and passive searching for evidence for insurance fraud.

There may be special requirements to become an insurance claims investigator. Some people move from private investigation or law enforcement work into this field. Others can study criminal justice at the college level, most often earning a bachelor’s degree prior to entering this field. Familiarity with state insurance laws is also vital, and any good investigator is going to have to know common means by which people attempt to commit insurance fraud.

Another of the requirements to become an insurance investigator may be state licensing. In some states investigators must be licensed as private investigators. This may vary, and people should look into their state or country laws to determine specific requirements.

In addition to requiring some studying and knowledge, any insurance claims investigator needs to have a finely trained mind: one that can spot deception easily, see patterns in gathered information, and look for ways to prove suspicions. People who may enjoy this field like logic, reasoning and puzzles, and aren’t afraid to do active detection work when required. A high degree of organization may also be needed, since sifting through all paperwork and gathered evidence is made more difficult when organization is haphazard.