Claims Investigator

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CLAIMS INVESTIGATOR

What do Claims Investigators do?

Claims investigator examine the facts of a claim to determine if the claim is valid. They decide the extent and validity of a claim, and in so doing, they prevent fraudulent claims by determining the claim's authenticity. Claims investigators also:

Coordinate the services that may be required by policy holders following an incident.
Help insurance companies to settle claims quickly.
Use a combination of tools including interviews and cutting-edge software to help evaluate claims.
Investigate defective products that may cause injury or damage, or may investigate events (such as an oil spill) for which a company may be liable.
Manage multiple cases with confidence and accuracy and respond well to working to meet targets and tight deadlines.
Prepare reports, maintain records and keep track of evidence trails and interview statements.

Claims investigators and forensic specialists have the option of being independent consultants, working for a variety of government and public organizations or working for insurance companies.

Some of the job titles associated with this field are corporate claims analyst, fire investigator, forensic engineer, forensic accountant, special investigator, construction claims analyst, forensic analyst, field investigations, independent investigator and fraud examiner.

Is this career for me?

The following qualifications may be required for a career as a claims investigator. Do these statements describe you?

A diploma in law enforcement or criminal justice would be an asset
Exceptional interpersonal skills
Sense of mutual respect and fairness
Demonstrates professional and ethical behaviour in all decision-making
Keen interest and experience in civil law, insurance law and rules of evidence and procedure
On-the-job experience with negotiation and law enforcement procedures
Computer proficiency

If you answered yes to these statements, then a career as a claims investigator might be the perfect fit!

How do I get there?

A variety of skill sets are necessary within the Claims Investigator profession. Your experience in one of the fields listed can lead you to a successful career in the insurance industry.

Law Enforcement:

If you possess extensive experience and education in the law enforcement field, then you are a perfect candidate for this role. General insurance knowledge, particularly that surrounding insurance law, will help you to excel in this career. Set a goal to acquire this while you are working in the industry - get connected to the Insurance Institute for more information about its programs and consider exploring additional certifications available through the Association of Certified Fraud Examiners.

Construction:

Your knowledge of structures, buildings and homes may make you a good candidate for this career choice. You may find law enforcement or criminal justice courses, offered by a local college, will enhance your skill set to better prepare you for this role. For additional information on such courses, contact your local college. General insurance knowledge, particularly surrounding insurance law, will increase your ability to succeed as an investigator. Set a goal to acquire this while you are working in the industry - get connected to the Insurance Institute for more information about its program offerings and consider exploring additional certifications available though the Association of Certified Fraud Examiners.

Environmental Science:

Your experience in the field of environmental science may make you a good fit for the role of Claims Investigator in cases with environmental consequences. Your knowledge of environmental systems and your research and investigation experience make this career a great choice. You may find law enforcement or criminal justice courses, offered by a local college, will enhance your skill set to better prepare you for this role. For additional information on such courses, contact your local college. General insurance knowledge, particularly surrounding insurance law, will increase your ability to succeed as an investigator. Set a goal to acquire this while you are working in the industry - get connected to the Insurance Institute for more information about its program offerings and consider exploring additional certifications available though the Association of Certified Fraud Examiners.

What does the future hold?

Earning potential for this role depends on education, experience, and geographic region. Much weight is given to those with specialized education (ie CIP designation), experience and skills. Many employers offer performance-linked bonuses.

Employment opportunities for claims investigators are expected to increase. The increase will be largely due to heightened fraud awareness combined with new laws and regulations. There is already a growing demand for professionals who are skilled at detecting and investigating fraud. New professionals to the field will be needed to replace retiring workers and serve an increasing population. These combined factors will create a substantial number of job opportunities.