Insurance Fraud Examiner Job Description

Insurance fraud examiner is a full-time investigator conducts insurance claims investigations, many of which contain elements of serious fraud. Such claims may involve staged car accidents, exaggerated workers’ compensation injuries, phony thefts and fake death claims.

Position Description

Insurance examiners carry out the financial review and audit of regulated insurance companies licensed to do business or seeking approval to do business. Field examiners who travel to an insurance company’s home office and audit its financial records do much of the work performed by Insurance Examiners. They assist the examiner-in-charge during on-premise examinations of regulated insurance companies.

In addition, they investigate policyholder complaints against insurance companies or insurance agents and brokers. They conduct investigations of alleged insurance fraud and recommend criminal prosecutions if violations of state laws are suspected.

Insurance fraud examiner regularly does the following:

  • Locate, gather, and disseminate evidence related to suspect insurance claims.
  • Conduct surveillance from motor vehicles, and covertly document activities of individuals, companies, and other entities.
  • Interview and obtain statements from claimants, witnesses, and other individuals.
  • Write compendious reports, suitable for submission to government agencies, courts, and insurance carries.

Skills Needed

The Insurance fraud examiner should have interrogation skills and needs to be aware of the legal restrictions of interrogating individuals. He will need to have excellent written and oral communication skills as the reports required will have to stand up in a careful and through investigation of being used in a court case. A good knowledge with legal and court procedures, including how to testify in court using the principles of fraud examination, is also required. The fraud examiner needs experience and training in four key areas: fraud prevention and deterrence, financial transactions, fraud investigation, and the legal elements of fraud.

Education Necessary for Application

  • A Bachelors Degree or equivalent relevant experience in investigations
  • Obtain a Certified Public Accountant or Certified Internal Auditor
  • A free driving record, without excessive violations
  • Excellent verbal communications and written skills

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