Insurance Fraud Investigator Job Description Example

By | August 26, 2023
Insurance fraud investigator job description, duties, tasks, and responsibilities
Insurance fraud investigators may also visit scenes of accidents to acquire photographic evidence that can be presented during court proceedings.

Insurance Fraud Investigator Job Description Example

What Does an Insurance Fraud Investigator Do?

Insurance fraud investigators conduct inquiries to verify insurance claims and detect the pattern behind dubious activities to take advantage of an insurance organization.

The insurance fraud investigator job description entails conducting research/interviews to identify and resolve cases of insurance fraud or scam.

Insurance fraud investigators handle cases of suspicious insurance claims to confirm if an incident is intentional or staged.

They usually conduct investigations, research, and interviews to obtain information regarding the nature of an incident.

Their investigations often require visiting the scene of an incident, taking photographs, and collecting useful evidence.

As part of their duties, insurance fraud investigators carry out background checks to discover the criminal history of claimants/suspects.

They set up surveillance around suspected individuals to obtain enough evidence for apprehending involved parties.

They also interview claimants and witnesses to obtain their statements concerning an incident.

Usually, insurance fraud investigators view video footages to establish the facts of a case.

They liaise with professionals from various fields, among which include doctors, police officers, and IT experts to assess the circumstances around a case and draw logical conclusions.

They also collaborate with legal attorneys to develop suitable action plan for addressing and resolving diverse cases of insurance fraud.

As part of their responsibilities, insurance fraud investigators analyze relevant documents, evidence and financial records to establish the pattern of an insurance crime.

They may work with a team of investigators to distribute the work load of a case in order to maximize efficiency.

They also prepare and present reports of an investigation to company management to guide their decisions as well as give recommendations on appropriate steps necessary for minimizing risk of fraud.

Insurance fraud investigators usually testify in court during a hearing, they also present evidence during court proceedings.

In fulfilling their role, insurance fraud investigators assist and solicit the help of law enforcement agencies in apprehending suspects.

Their work description also entails preparing proposals for the prosecution of guilty suspects and restitution of defrauded asset.

The insurance fraud investigator job requires a Bachelor’s degree in business administration, criminal justice, insurance studies, or in a related discipline.

Some of the qualities needed for success in this position include research and interview skills and ethical qualities.

Insurance Fraud Investigator Job Description Example/Template

The role of the insurance fraud investigator entails the duties, tasks, and responsibilities shown in the job description example below:

  • 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.

Insurance Fraud Investigator Resume Preparation

Are you looking to create an insurance fraud investigator resume? If so, then the duties highlighted in the sample job description above can serve as a useful reference in completing the work experience section of your resume.

If you have worked before as an insurance fraud investigator, you need to have a job experience section in your resume that shows the functions you carried out, for employers to have confidence that you will be effective on the job if hired.

Requirements – Skills, Abilities, and Knowledge – for Insurance Fraud Investigator Job

If you are thinking of working as an insurance fraud investigator, the following are the common requirements most employers will expect you to fulfill to access the job:

  • Education and Training: To become an insurance fraud investigator you require a Bachelor’s degree in disciplines such as business administration, criminal justice, and insurance studies. Experience in a law enforcement or investigative field is also essential for the job position
  • Research Skills: Insurance fraud investigators are adept at conducting inquests to discover discrepancies in insurance claims
  • Interviewing Skills: Insurance fraud investigators are able to interview witnesses to obtain information useful in establishing the facts of an investigation
  • Ethical Qualities: Insurance fraud investigators maintain a high level of professionalism when handling a case to ensure effective and unbiased resolution of a case.

Insurance Fraud Investigator Skills for Resume

Again, if you are looking to create an insurance fraud investigator resume, the above mentioned skills and qualities can be useful in filling out the skills section of the resume.

Acquiring the above qualities, which most employers for the position usually require, and using them in making the skills section of your resume will make the resume stronger and appealing to employers.


This post provides the detailed duties and responsibilities of insurance fraud investigators, which will help you to understand what they do better if you are interested in the career.

Also, the given sample work description above can serve as a template for making a suitable job description for the position if you are an employer needing to hire for the position.

Did your knowledge of what insurance fraud investigators do increase from reading this post? Please leave a comment of what you think about this article in the box below. You may also share experience of your work as an insurance fraud investigator if you have any.