Insurance companies would not require insurance claims investigators if insurance fraud did not occur. Unfortunately, there are numerous types of insurance scams and false claims, and insurance companies may lose a significant amount of money if they simply pay out on claims that they suspect are suspect. To avoid this loss, many insurance companies employ or hire at least one insurance claims investigator to ensure that only legitimate claims are paid.
When a company suspects fraud, it usually seeks the assistance of an insurance claims investigator. Suspicion may arise during the initial examinations of a claim, which may be performed by insurance examiners or adjusters. The case will be reviewed by the investigator, who will go over all of the information provided by the company and the claimants. He or she may also conduct a limited investigation into the claimants to see if they have any information from their past that could indicate fraudulent behavior in the present. Searches for criminal records may be conducted, and the investigator may look for evidence of collusion between claimants and witnesses. Anyone involved in the claim may be re-interviewed.
In some cases, the insurance claims investigator is out in the field, not just sifting through witness/claimant information. He may be called upon to conduct surveillance or investigate an accident scene. The job can be active or passive in nature, depending on whether you’re looking for evidence of insurance fraud.
To work as an insurance claims investigator, you may need to meet certain qualifications. Some people enter this field after working in private investigation or law enforcement. Others can study criminal justice in college, earning a bachelor’s degree in most cases before entering the field. Knowledge of state insurance laws is also essential, and any good investigator will need to be aware of the most common methods used by people to commit insurance fraud.
State licensing may be one of the requirements for becoming an insurance investigator. Private investigators are required to be licensed in some states. This can vary, so people should check their state or country’s laws to see what they need to do.
Any insurance claims investigator must have a finely trained mind, one that can easily spot deception, see patterns in gathered information, and look for ways to prove suspicions, in addition to some studying and knowledge. People who might be interested in this field enjoy logic, reasoning, and puzzles, and aren’t afraid to perform active detection work when necessary. It’s also possible that a high level of organization will be required, as sifting through all of the paperwork and gathered evidence becomes more difficult when organization is haphazard.