Types of Insurance investigators

Posted: Fri Dec 11, 2009 06:12 am Post Subject:

I guess the claims investigator and the fraud investigator are different profiles. The claims investigator seems to be a person who'd evaluate and investigate the discrepancies arising out of a claim. On the other hand the fraud investigator seems to be someone who steps in to investigate any alleged fraudulent activity between the carrier and it's clients.

Posted: Mon Dec 14, 2009 08:24 am Post Subject:

An Insurance fraud detective probably has the same role as that of the frauds investigator. They're here to investigate suspected claims. Different carriers have different parameters to evaluate fraudulent claims and hence set specific criteria as per their requirements.

Posted: Tue Dec 15, 2009 09:40 am Post Subject:

A college degree is not a must to qualify for being a fraud detective. But at the same time a majority of the insurance carriers prefer candidates who'd been to colleges. People who've studied criminal justice are also preferred.

Posted: Wed Dec 16, 2009 05:56 am Post Subject:

I guess it's better you sit for the CIFI exam. Once you've passed it, look for 'insurance fraud' profiles across major career-related search engines. Don't forget to mention your being a CIFI while you forward an application.

Posted: Fri Dec 18, 2009 12:01 pm Post Subject:

I've heard that some organizations offer a certification on insurance fraud investigation. This course might just equip you to face the challenges in a better way. You could also become a good resource to satisfy different positions within the industry. You'll come across a number of such courses if you'd search online.

Posted: Sat Dec 19, 2009 10:33 am Post Subject:

You could search for advertisements across job boards in the internet. You could also visit websites belonging to insurance giants and see if they're hiring for investigator positions.

Posted: Mon Dec 21, 2009 08:50 am Post Subject:

It's quite up to the insurance agents to call on the investigator. Circumstances wherein an agent suspects staged car accidents or fraudulent hospitalization bills, he'd invite an investigator for the claim review. Insurance frauds may be committed by a single individual or a group of individuals. Such groups may even include high-end professionals like claimants, attorneys and doctors.

Posted: Wed Jan 20, 2010 04:55 pm Post Subject:

I've been investigating Insurance Fraud for a little more than 16 years. My title, however, may be considered misleading by some because I specialize in the investigation of life insurers (the dishonest agents and their companies).

On my CV, I note that I am licensed and/or qualified to investigate * Basic Workers' Compensation Anti-Fraud Training * Training for Integral Anti-fraud Personnel: Strategies for Implementing New State Regulations * Arrested Developments: Latest Anti-Fraud Trends * California Insurance Regulations Update * Developing and Implementing Fraud Training Programs * Leveraging Cutting Edge Techniques to Recover Monies from Perpetrators of Fraud * Investigating Auto Theft and Bodily Injury Fraud * Workers Compensation Premium Fraud * A Look at Fraud from the Top down. Working with the Governor and Insurance Commissioner to Implement Meaningful Fraud Programs in California
* Major Case: Implementing a Proven Technique to Reduce Organize Fraud * Forging Relationships with Prosecutors to Reduce Insurance Fraud * Communicating with the Media: A Panel Discussion.

I will admit there are many people in America who are much better than I am at investigating most of the points I've noted above. However, when it comes to the investigation of dishonest life insurance agents and the companies they represent, there are very few (if any) better.

A college education has always been very important to me and I hope to finish my MBA some day. With one exception, every one of my employees holds a college degree, but this wasn't required when I hired them.

The investigators who work for me either are or have been very experienced insurance agents and I have personally trained each them in my particular style of investigation. I wouldn't hire someone who isn't an agent because they wouldn't have the field-knowledge an agent has and, for deposition purposes, they wouldn't be similarly qualified to the agents we're investigating. Most courts tend to place great value in this.

A number of colleges, Eastern Kentucky University, for example, have great Insurance Education programs. I am friends with one of the Insurance Theory Professors at EKU and know they have a great program.

There are also the down-sides of my profession. 18-hour days, being couped up in hotel rooms while speed-reading deposition transcripts, deadlines, travel, attorneys who shouldn't be practicing law, death threats, depositions, etc. Because I only get paid when cases settle (outside my retainer fee) I have to be pretty good at budgeting as well.

If an elderly couple is been coerced into transferring their entire life savings into a brand new state-of-the-art Universal Life policy because it will always generate around a 12% return and be the best retirement supplement ever, many insurance companies know something "might be" wrong with the plan but will generally do nothing to fix the problem.

When someone like me comes along, they'll fight tooth and nail to prove their agent did nothing wrong and the old people are liars. Later on, however, when the insurance company agrees to write a big check to make the problem(s) go away - while never admitting they've done something wrong - and the agent has their license suspended or revoked, it's all worthwhile.

Posted: Wed Mar 30, 2011 08:21 am Post Subject:

Well there are mainly two types of adjusters. First is inbound and other is outbound.

In house adjusters can also be called as Loss adjusters whereas outhouse adjusters are called independent adjusters.

Public adjusters/Loss assessors are licensed and experienced professionals. They try to bridge the gap between the insurers and the insured. They work solely for the insured i.e. the policyholders or claimants.

Posted: Wed Jan 11, 2012 10:40 pm Post Subject: types of insurance fraud

Types of fraud insurance investigation:
Health insurance fraud investigation. This investigation tries to determine whether someone is getting paid for health care that they are not receiving or is filing health care claims and requests that are not valid or needed.
Car insurance fraud investigation. Some criminals stage accidents, in which they purposely collide with another car and then try to accuse the other driver of an accident in order to file claims. Some criminals attempt vehicle theft fraud, trying to get money for a car which was not, in fact, stolen. Insurance fraud investigators uncover these schemes.
Home insurance fraud investigation. In this type of insurance investigation, investigators discover disaster fraud, which includes false claims of damage. They also investigate property fraud to find evidence against those who make false claims about property damage.
Life insurance fraud investigation. Investigators work to uncover cases of people who claim life insurance while still alive or those who claim too much in life insurance.
Workers compensation fraud investigation. Insurance investigators work to find evidence of workers who claim compensation when not as injured as they claim.
Insurance company investigation. Investigators also work to uncover evidence of bad business practices at insurance companies. If an insurance company takes your money but does not compensate you as promised, a professional investigator can help you make your case in court.

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