What They Do:

As an insurance fraud investigator, your job is to investigate an insurance claim on behalf of your firm to determine whether or not fraud has occurred in any given case. Insurance fraud investigators frequently travel to examine claim sites in person, and you may be asked to do so on short notice.

Why It's Important:

Insurance fraud investigators are key to exposing fraudulent claims. Once insurers suspect fraud may be occurring, they hire insurance fraud investigators. These investigators work in a variety of ways to collect evidence. Evidence can give insurance companies the leverage needed to negotiate their claims.

Typical Duties:

  • Interview claimants and witnesses to obtain oral and written statements regarding a case

  • Carry out background checks to verify the criminal history and records of a claimant/suspect

  • Conduct investigation and research to uncover the pattern of an insurance fraud and the parties involved

  • Set up and implement programs for the recovery/restitution of lost funds/asset

  • Collaborate with government agencies and antifraud authorities to address and resolve large scale insurance fraud

  • Examine documents to verify it’s authenticity and possibility of a forgery

  • Visit accident scenes to obtain information useful in determining if an incident was staged

  • Set up surveillance to gather information essential in establishing the facts of a case

  • Liaise with medical professionals to verify if an injury or illness is being exaggerated to cash in an insurance claim

  • Take photographs of an accident scene to secure evidence which can be presented during court proceedings

  • Work with attorneys to press charges and develop strategies for the resolution of an insurance fraud

  • Write reports of an investigation and proffer recommendations to company management on ways to limit risks of insurance fraud

  • Testify as expert witness during a court hearing

  • Liaise with forensic scientists to analyze items recovered from a scene

  • Maintain an up-to-date knowledge of changes/trends in an insurance/financial institution

(Mouse over yellow box to close)

Important Skills:

  • Critical Thinking Skills

  • Decision Making Skills

  • Research Skills

  • Interviewing Skills

  • Reading Skills

  • Writing Skills

  • High level of professionalism and ethical standards

Salary Range

The median annual wage: $48.211

The lowest 10% ~ $23,500

The highest 10% ~ $89,500

Professional Designations:

Certified Insurance Fraud Investigator (CIFI)

Certified Insurance Fraud Analyst (CIFA)

Certified Insurance Fraud Representative (CIFR)

Career Facts

Education and Professional Requirements:

  • Entry-level: Bachelor’s degree or equivalent law enforcement or claims experience

  • Advancement: Bachelor’s degree, multiple years of related work experience

 

Possible career path: Fraud Examiner > Senior Examiner > Manager, Special Investigations Unit

Additional Resources

References:

  • OII Fraud Investigator Profile

  • InVEST Fraud Investigator Profile

  • IIC Fraud Investigator Profile

  • IMUA Claims Overview

  • US Bureau of Labor Statistics Occupational Outlook Handbook

Videos:

  • Meet a Fraud Investigator

  • Inland Marine Underwriters Association Career Path Video