Insurance Investigators

It is usual for the claims adjusters to convey such claims to the investigators whenever there seems a certain element of insurance fraud involved in them. Insurance Investigators are professionals who would form a significant part of an insurer's claims investigation division. Their primary objective is to deal with claims involving one or more of the following fraudulent activities within the insurance industry.

• Fire-raising

• False Disability Claims forwarded by workers

• Deliberate accidents

• Exaggerated Healthcare treatments

The degree of fraudulent cases may differ between the claimants due to misrepresentation of facts. Such malpractices may range from false description of vehicle damages to manipulation of hospital bills caused by a team of medical professionals. Such fraudulent activities would often involve attorneys as well as insurance professionals.

Investigators would begin analyzing claims through a background search of claimants & the associated witnesses. It is easier for the investigators to assess the involvement of a claimant over an insurance fraud through a careful study of some relevant factors to which they have an easy access.

• Claimant's personal data

There is every possibility that he might come across a piece of information that has been overlooked.

• Social Security Information

This information is very important since the social security number is associated with much of the financial proceedings in the claimant's life.

• Use of a pseudo

Investigators are bound to look for any such identities used by the claimant for business or other associated financial work, which have remained undisclosed with the insurer.

• Driving License Number

It is truly important to know whether the claimant is at all authorized to drive under any state & also the guidelines he ought to follow in this regard.

• Contact Information

The contact information of the claimant would always help the investigator to locate & identify him.

• Criminal History

A thorough background check reveals whether the claimant was ever involved in any form of scam which he may have kept from the insurance company.

• Claims Record

Investigators would need to check whether the claimant had ever filed any claim in the past & also study the nature & outcome of such claims.

All of this information would get the investigators a fair idea of the claimant's financial stability & his probability of defrauding them. They may need to judge the above mentioned information on the basis of some relevant documents followed by a close inspection of specific places inhabited by the claimant from time to time.

It is the investigators' right to check all the information associated with the claimants & witnesses on the basis of the following factors:

• Statement on record

• Associated photographs

• Relevant sites

• Healthcare licenses

It falls within the investigators job to seek the help of attorneys & may pose as serious witnesses to certain legal cases. Investigators are needed to conduct certain surveillance job while they are at work. If we study a particular case referring to fraudulent Workmens’ Compensation claims, we see that the investigator would secretly monitor the activities of the claimant for a considerable period of time. At any point of time within this period if the investigator gets a proof that the claimant is involved in any form of activity that is barred by the injuries mentioned in his claim, he would take photographs from under cover. Following this act, the investigator is supposed inform the insurance company about the proceedings.

Investigator Hiring Process

Insurers would generally prefer the following personnel for the position of insurance investigators-

• Claims officers

• Civil servants

• Private detectives

All of these groups are expected to be highly proficient in interpersonal skills. Once they get involved within the work force, they would specialize in claims processing & settlement issues. The trainee investigators are gradually expected to share the burden put on their seniors as they deal with more assignments. The insurers would seek professionals who are effective & capable of imagining things in the bigger perspective. They should be well conversant & endowed with knowledge.

With the progress in time, the investigators are needed to reflect considerable competence in claims processing. Ones who would exhibit administrative skills could be assigned with more challenging but respectable designations. Claims investigators would thus have the opportunity to move up as highly efficient managers within the investigation department. They would have the option to become independent adjusters or establish their own damage appraising firms at a later date.