According to the fbi, the insurance industry includes more than 7,000 companies that receive more than $7 billion in premiums each year. It is estimated that the total cost of insurance fraud in the us. uu. exceeds $40 billion each year. Insurance fraud is a widespread and widespread problem in the United States costing the average American family between $400 and $700 each year in premium increases.
The Coalition Against Insurance Fraud estimates that incidents of insurance fraud steal at least $80 billion each year from American consumers. Fraud has also been reported to occur in approximately 10% of these property and casualty insurance losses, resulting in a loss of about $30 billion each year.
It should come as no surprise that insurance companies and businesses aggressively prosecute insurance fraud at all levels and in all industries. In fact, according to the Coalition Against Insurance Fraud, 41 states have now enacted laws to create insurance fraud bureaus that have even more than 45,000 cases open for investigation in 2010 alone, which has evidently increased tremendously by 2021, according to reports. Similarly, the findings measure that in 2019 and 2020 property and casualty fraud would total $38 billion each year.
Due to the sheer size of the insurance industry, insurance investigators are more in demand than ever. Some $3.1 billion in false and fraudulent claims are even reported in 2020. There is absolutely no industry that is safe from insurance fraud.
In addition, lexisnexis conducted a survey in 2016 that reported that raud schemes were of great concern to people, with identity theft rising to 49%, hacking to 45%, employee-agent fraud at 37% and insurance claims fraud at 34%. percent. Now that you understand the great need for insurance investigators, read on to learn more about becoming an insurance investigator.
These qualified professionals, who may work in the private commercial sector, for insurance companies, or for state or federal insurance fraud bureaus, are responsible for uncovering evidence and information related to insurance fraud that is admissible in court of justice.
Just a few of the insurance industries where insurance investigators work include:
- medical insurance
- homeowners insurance
- car insurance
- life insurance
- workers compensation insurance
- unemployment insurance
- disability insurance
- property insurance
- filing false insurance claims
- lying on insurance forms and applications
- exaggerating an injury or illness for monetary gain
- car collisions, injuries, home invasions, fires, etc.
- hide pertinent information on insurance forms and applications
- acts of collusion
- types and options of insurance
- claim investigations
- financial risk management
- insurance fraud terminology
- use of software
- organized fraud case study
- medical fraud case study
- fraud prevention and deterrence
- financial transactions and fraud schemes
- law relating to the conduct of fraud examinations in criminal and civil law
- investigations related to interviews, taking statements and obtaining information
insurance fraud investigations at work
Insurance investigators are usually called when an insurance business, organization, or company suspects fraud. These professionals can be employed by a company; they can work independently as contractors; they may be employed by a state or federal agency; or they may be employed by a private consulting firm.
The goal of an insurance investigator is to gather the evidence necessary to pursue monetary damages and/or a civil or criminal conviction.
The scope of an insurance investigator’s job is broad, as insurance fraud can take many forms, including:
An insurance investigator typically begins a fraud investigation when an insurance business or company decides to evaluate a suspicious insurance application or claim. Often insurance examiners and insurance adjusters, after reviewing the application or claim, report their suspicions to the company, who then contacts an insurance investigator to further investigate the claim.
Insurance investigators may conduct surveillance, gather scene information, consult with experts and law enforcement officials, and check a claimant’s credit history or background to gather relevant information. once the investigative process is complete, a report containing the findings is usually sent to the appropriate legal professionals, who may go to law enforcement and file civil and criminal charges.
Beyond the initial investigation, insurance investigators may be called to testify at a court hearing about their findings.
how do i become an insurance investigator?
Individuals seeking careers as insurance investigators are best served by earning a bachelor’s degree in criminal justice or a related program. Industry knowledge is also very important, so people with degrees in business administration, finance, or risk management may find more career opportunities.
are you ready to become an insurance investigator? Find the private investigator license requirements in your state.
Valuable courses for aspiring insurance investigators should include:
Most states require insurance investigators to be licensed as private investigators, which requires a specific set of education and experience requirements, as well as a written test in some cases.
professional certification for insurance investigators
professional certification allows insurance investigators to show a commitment to their profession and achieve better salaries and greater mobility within the field:
The International Association of Special Investigation Units offers the Certified Insurance Fraud Investigator (CIF) Program, which is designed for individuals seeking advanced skills to detect, investigate, and deter insurance fraud. To qualify for this program and receive professional certification, individuals must have a minimum of three years of insurance fraud analysis experience and a bachelor’s degree.
Individuals can qualify for the program without a bachelor’s degree, as long as they can demonstrate at least 10 years in the insurance industry, or 5 years in the insurance industry and 5 years of military or law enforcement experience to receive their title or insurance researchers certificate.
All candidates for this program must pass an exam, which covers the following topics:
The Association of Certified Fraud Examiners offers the Certified Fraud Examiner (CFE) designation, which requires a bachelor’s degree from an accredited college or university and at least two years of professional experience directly related to detecting or deterring fraud. Applicants must pass an exam to become certified as a CFE, which tests individuals in the following areas:
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