A lot of people and big business houses purchase insurance policies to insure valuable and costly objects against any kind of monetary losses. When some loss occurs, the policy holder claims or makes requests to get the insured money as a compensation for their loss. This is where people like claims adjusters, examiners, appraisers and investigators step in.
The adjusters and examiners investigate into the claims, make settlements, and authorize the payments. The appraisers make an estimate of the value of the item that is insured. The role of an insurance investigator is the most vital one because he has to review cases that pose chances of fraud or any misconduct. In this whole process, the job of investigator is the most challenging , attractive as well as demanding.
In many cases, the functions of the all these people becomes intermingled. But in the usual process, whenever the examiner or adjuster suspect mixed feelings in a case, they simply refer it to the insurance investigators. Note that the severity of a fraud can vary differently. Sometime there may be a staged accident, a false disability claim and sometimes even unnecessary medical expenses.
Therefore, an insurance investigator must complete a background search of the claimant as well as the witnesses. He must also check social Security numbers, drivers license numbers, aliases, addresses, criminal records, phone numbers, past claims histories, and medical records etc. Then the investigator records the sentence of the claimant. He may also examine the doctors license from which the claimant is getting treatment if any suspicion arises. He may also perform surveillance work in cases where the claimant applies for a disability benefit. This is actually to confirm whether he is really disabled or not. If he suspects any activity that goes against the condition stated, he may use it as a evidence in the courts also.
Working hours of an insurance investigator is quite irregular. This is because he has to make surveillance and meet people who are not available in the normal working hours. They may be required to work in the early mornings, late evenings, on weekdays and even on holidays. In few cases, he can be in the office like when he prepares databases or writes reports.
Regarding the educational qualification, there are no strict rules. But insurance companies prefer people who have some legal background. Even people who possess experience as examiners and adjusters are eligible to work as insurance investigators. The necessity of a license depends on the area in which an investigator is working.
In terms of qualities, an insurance investigator should be have a razor-sharp analytical mind. He should also be daring, assertive, with an eye for minute details and good communication skills. The salary of an insurance investigator varies with the reputation of the company and also the relevant experience of the investigator.
Insurance carriers, brokerages, agencies, private claims adjusting companies are the type of companies from which an insurance investigator normally gets his job.