Profession insurance fraud investigator

Insurance fraud investigators combat fraudulent activities by investigating the circumstances of certain suspicious claims, activities related to new customers, buying insurance products and premium calculations. Insurance fraud investigators refer potential fraud claims to insurance investigators who then undertake research and investigations to support or deny a claimant's case.

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Personality Type

Knowledge

  • Claims procedures

    The different procedures that are used to formally request a payment for a suffered loss from an insurance company.

  • Principles of insurance

    Understand the principles of insurance, including third party liability, stock and facilities.

  • Insurance law

    The law and legislation concerning the policies of transferring risks or losses from one party, the insured, to another, the insurer, in exchange for a periodic payment. This includes the regulation of insurance claims and the business of insurance.

  • Actuarial science

    The rules of applying mathematical and statistical techniques to determine potential or existing risks in various industries, such as finance or insurance.

  • Fraud detection

    The techniques used to identify fraudulous activities.

  • Types of insurance

    The various types of risk or loss transfer policies that exist and their characteristics, such as health insurance, car insurance or life insurance.

Skills

  • Conduct financial audits

    Evaluate and monitor the financial health, the operations and financial movements expressed in the financial statements of the company. Revise the financial records to ensure stewardship and governability.

  • Detect financial crime

    Examine, investigate, and notice possible financial crimes such as money laundering or tax evasion observable in financial reports and accounts of companies.

  • Interview insurance claimants

    Interview people who have filed claims with the insurance corporation they are insured with, or through specialised insurance agents or brokers, in order to investigate the claim and the coverage in the insurance policy, as well as detect any fraudulous activities in the claims process.

  • Review insurance process

    Analyse all documentation related to a specific insurance case in order to ensure that the application for insurance or the claims process was handled according to guidelines and regulations, that the case will not pose significant risk to the insurer or whether claims assessment was correct, and to assess the further course of action.

  • Analyse claim files

    Check the claim from a customer and analyse the value of the lost materials, buildings, turnover or other elements, and judge the responsibilities of the different parties.

  • Assess customer credibility

    Communicate with customers to assess whether their true intentions are in line with what they claim in order to eliminate any risks from a potential agreement with the customer.

  • Assist police investigations

    Assist in police investigations by providing them with specialised information as a professional involved in the case, or by providing witness accounts, in order to ensure the police have all relevant information for the case.

Optional knowledge and skills

manage claims process prepare financial auditing reports classify insurance claims perform debt investigation debt systems document evidence collect property financial information interpret law obtain financial information present evidence trace financial transactions manage claim files analyse financial risk