Insurance Claims Investigator Job Description, Key Duties and Responsibilities

Insurance Claims Investigator job description, duties, tasks, and responsibilities.
Insurance Claims Investigators ensure a client’s claim on an accident situation is without fraud.

Insurance Claims Investigator Job Description, Key Duties and Responsibilities

This post provides complete information about the job description of an insurance claims investigator, to help you learn about what they do.

It highlights the key duties, tasks, and responsibilities that commonly make up the insurance claims investigator work description in most organizations.

This article also provides the major requirements that individuals seeking the job of insurance claims investigator are typically expected to fulfill to be hired.

Please, continue reading to improve your knowledge of the insurance claims investigator career:

What Does an Insurance Claims Investigator Do?

An insurance claims investigator is responsible for collecting, gathering, and analyzing forensic evidence from accidents or crime scenes, and interviewing witnesses and various job professionals in order to successfully investigate, differentiate, and sort fraud activities from the real accidents before claims of compensation by claimants are made.

The insurance claims investigator job description entails carrying out several important tasks such as managing simple fraud cases that involve paperwork that is improperly filed or have false identities.

It also involves handling cases of fraud through the means of arson or theft, and effectively spending as much time as required to gather forensic evidence from crime scenes or accident locations.

Accidents or events such as theft, fire, and so on are liable to happen in several situations, and these tragic incidences demand a claim of compensation from the insurance company, while some of these events might be faked or made up.

Therefore, it is important for an insurance company or organization to hire an insurance claims investigator in order to conduct thorough research and interview claimants, witnesses, attorneys, police, and medical professionals in order to gather facts and documents and determine if what the claimant is stating is true, if the submitted documents are genuine, and whether the insurance organization can settle the claim or not.

In other words, an insurance claims investigator refers to an individual who is responsible for assisting an insurance company or organization in the development, implementation, and maintenance of an accident reporting and complaint management procedures.

An insurance company also expects the hired claims investigator to examine claims for a wide range of offenses such as over-reporting of damaged to insured properties, staging of automobile accidents, faking disabilities or death, and so on.

His/her work description also involves investigating the insurance company’s own employees for misconduct, vices, or illegal activities.

Other activities that are carried out by an insurance claims investigator may include specializing in the medical discipline and focusing on a specific type of fraud such as unnecessary medical treatments, or stolen medical equipment.

Working in the position of an insurance claims investigator requires the individual to possess and demonstrate crucial and required skills or characteristics such as good communication and interpersonal skills, high detail-oriented skills, and an enquiring and inquisitive mind; sound negotiation skills, ability to efficiently make effective decisions, and several other important work ethics.

In terms of academic qualifications, the ideal candidate for the insurance claims investigator role is required to possess at least a High School Diploma and have studied subjects like Business/Management, Economics, Law, and Mathematics.

Most employers also prefer candidates who possess several years of professional experience as law enforcement agencies or forensic laboratory technicians.

Insurance Claims Investigator Job Description Example/Sample/Template

Insurance claims investigators perform various functions in ensuring that a client’s claim on an accident situation is without fraud.

Shown below are major duties, tasks, and responsibilities that commonly constitute an insurance claims investigator job description:

  • Conducting investigations on various suspicious insurance claims, which may also include claims that are suspected to have originated from fraud, criminal activities, falsified or false documents; arson or unnecessary medical procedures
  • Recording correct and accurate data and statements in reports
  • Paying visits to the accident scene and investigating several circumstances
  • Working in relation or co-operatively with solicitors and negotiating payment
  • Examining and reviewing photographs, documents, and statements
  • Researching audio or video surveillance and carefully watching them for clues
  • Testifying in court cases when a claimant is guilty and accused of fraud
  • Giving feedback on all activities to the insurance organization for final determination
  • Examining a range or series of factual information during investigations, which may also include a claimant’s background
  • Making arrangement for payments and any other required activities.

Insurance Claims Investigator Job Description for Resume

If you have worked before as insurance claims investigator or are presently working in that position and are making a new resume, you can make the professional experience section of your resume with information from the sample claims investigator job description provided above.

The professional experience section of your resume gives you the opportunity to highlight the duties and responsibilities you have performed as an insurance claims investigator or are currently carrying out.

This will help increase the strength of your resume and your chances of being employed as most recruiters give preference to candidates with relevant experience to the available position.

Insurance Claims Investigator Requirements – Skills, Knowledge, and Abilities

If you are seeking the job of insurance claims investigator, you should be prepared to meet recruiters’ requirements for the position.

To find and hire the right candidate who can effectively perform the obligations, objectives, and purpose of the insurance claims investigator role, employers commonly list a set of requirements prospective candidates should meet to be considered for hiring.

Shown below are major requirements to meet to be considered for hiring for an insurance claims investigator position:

  • Good verbal and written communication skills to liaise effectively with various job professionals, witnesses, the insurance organization, or claimants so as to conduct investigations
  • Strong negotiation skills to liaise with solicitors and negotiate payment
  • Thorough knowledge of insurance law
  • Good organizational and time management skills to work effectively even under pressure, and also to complete tasks within a given timeframe
  • An enquiring mind and sound mathematical skills to efficiently carry out effective investigations, which may also include putting suspects on surveillance
  • Several years of professional work experience in a related industry or any of the fields stated earlier
  • At least a High School Diploma, and must have studied subjects like Business/Management, Economics, Law, Mathematics, or any related discipline.

Conclusion

If you are an employer, HR manager, or recruiter and are hiring for the insurance claims investigator position in your organization, you are expected to publish the description of the role.

This will help to inform prospective candidates of the duties and responsibilities associated with the claims investigator job, for them to decide if they will be able to carry them out effectively.

You can apply the insurance claims investigator duties and responsibilities provided in the job description example above in creating the perfect description for the role in your company.

This will enable you to attract the best candidates to your offer, from which you are sure of hiring your ideal claims investigator.

This post is also valuable to individuals interested in the insurance claims investigator career; they can learn about what the role does and then be able to decide if that’s what they want to do.

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