A fraud agent’s responsibilities typically include investigating cases or instances in which a business or organization suspects a fraudulent action has occurred. This type of agent is typically employed a financial institution, such as a bank, insurance company, or money lender, and reviews or investigates various reports. This usually starts with a general overview of paperwork filed and claims made, but it may also necessitate field research and investigation to observe people or conduct interviews. A fraud agent usually wraps up a case writing a final report that is filed with his or her employer and includes recommendations for further action.
One of the first things a fraud agent, also known as an investigator or officer, does is obtain and review cases that could be fraudulent. When an insurance company receives a claim from a client, for example, the paperwork may be sent to the agent. The agent then examines this information to determine its initial legitimacy, which may include double-checking the claim’s basic information and ensuring it is properly filled out. A fraud agent may approve the paperwork and pass it along at this stage, or they may decide that further investigation is necessary.
A fraud agent working for an insurance company, for example, might decide that a claim is suspicious and interview the person who filed it. Speaking with medical or legal professionals involved with the person making the claim, as well as ensuring that the information provided the claimant is legitimate and accurate, are examples of additional research. A fraud agent at a bank or money lending institution might run a background check on someone based on references provided on paperwork. The nature of the research conducted during an investigation varies depending on the circumstances, but it is usually done to determine the validity of a claim.
Once a fraud agent has determined that the paperwork is correct, he or she can give his or her employer additional instructions. If no suspicious activity is discovered during the investigation, the officer may recommend that a claim or loan be approved. When research or background checks reveal that there is a possibility of fraud, the agent will most likely advise his or her employer to deny the claim. When this type of fraud or abuse is discovered, there are often legal ramifications, so a fraud agent may need to contact law enforcement and provide them with the information he or she has gathered.