What does a Claims Investigator do?
Published 4 min read
A claims investigator is responsible for investigating insurance claims to determine whether they are valid. This may involve interviewing witnesses, reviewing documents, and conducting research. The goal is to determine whether the claim should be paid and, if so, how much.
Claims Investigator job duties include:
- Investigate insurance claims to determine validity and liability
- Interview claimants, witnesses, and doctors
- Gather evidence through surveillance, public records searches, and background checks
- Analyze medical reports, police reports, and other documentation
- Prepare detailed reports of findings
- Present findings to insurance adjusters or attorneys
- Testify in court as needed
- Stay up to date on changes in state and federal laws governing insurance claims
- Maintain accurate records of investigations
Claims Investigator Job Requirements
A Claims Investigator typically needs at least a high school diploma, although some jobs may require postsecondary education, and most jobs will require some on-the-job training. Many organizations also require investigators to be certified, and experience is always helpful. The best way to become a claims investigator is to start working in the insurance industry in a related position, such as customer service or claims processing.
Claims Investigator Skills
- Analytical skills
- Attention to detail
- Communication skills
- Computer skills
- Interpersonal skills
- Interviewing skills
- Observation skills
- Organizational skills
- Problem-solving skills
- Research skills
- Writing skills
Related: Top Claims Investigator Skills: Definition and Examples
How to become a Claims Investigator
A Claims Investigator is a professional who investigates insurance claims. Insurance companies hire Claims Investigators to protect themselves from fraudulent claims.
There are many ways to become a Claims Investigator. The most common way is to have a background in law enforcement or insurance. Many investigators have a college degree in criminal justice or a related field. Some investigators are former insurance adjusters or insurance company employees.
Most Claims Investigators start their careers working for an insurance company. They may be assigned to investigate suspicious claims, or they may work on a team that investigates all claims filed with the company. After gaining experience, some investigators start their own businesses.
There are many skills that are important for Claims Investigators. They must be able to communicate well, both in writing and verbally. They must be able to gather information from witnesses and claimants, and they must be able to analyze that information to determine if there is fraud involved. Investigators must also be able to work independently and be self-motivated.
If you are interested in becoming a Claims Investigator, there are several things you can do to get started. You can start by shadowing an experienced investigator, or by taking classes in fraud investigation or insurance law. You can also volunteer with organizations that investigate insurance fraud, such as the National Insurance Crime Bureau (NICB).
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