An insurance fraud investigator is a person who has successfully completed their online diploma in investigation and security and has found employment with an insurance company. The objective of the investigation is to determine if an insurance claim has been made without basis and under false and misleading pretenses. Many investigations involve disability claims, often the claimant will state that their quality of life has been impaired because of chronic pain; chronic pain is very hard to prove medically so the investigator may be assigned to covertly watch the individual, observing his or her activities and limitations.
Large insurance companies usually have enough cases where fraud is suspected to employ a full time fraud investigator. If this is not the case and there is not enough demand for a full time investigator the alternative is to employ a private investigator, contracting the precise services that are required when required. Many who have gained their online diploma in investigation and security are involved in private practice.
When an insurance company has reason to suspect fraud they will assign an investigator to the case. The investigator normally begins by gathering information of the suspect. A case file will be started; the file will contain any contact information such as address and telephone number as well as details on the complaint. This information is used by the investigator to determine the validly of the claim. If, for example, the claimant stated that he did not have the use of his legs, it is up to the investigator to confirm or deny this.
To conduct the investigation the investigator may use some reasonably technical equipment which can include remote surveillance by video although in most cases handheld still and video cameras suffice. Using the example given, if the investigator sees that the claimant is indeed confined to a wheelchair then it is reasonable to conclude the claim is valid. If however, the investigator sees the claimant sees playing basketball with kids in the area this will be documented and reported back to the insurance company.
If the individual is receiving benefits they will normally be suspended and the findings of the insurance fraud investigator will be turned over to a lawyer for recovery action. As a result of the work the investigator did the insurance company may elect to file either criminal or civil charges, if this is the case the investigator will be called upon to give testimony during the court proceedings.
An online diploma in investigation and security leads to a very exciting and rewarding career in a number of fields. To learn more you are invited to contact the American College of Health & Technology.
