Claims for any damages reported to an insurance company by a private individual or company are, in general, thoroughly investigated. This is the only way for the insurance company to determine if a claim is valid, and just how much should be paid out to the claimant. Fraud is sometimes uncovered during an investigation of a claim. In this case, the role of an investigator is two-fold: in addition to serving the interests of the insurance company by trying to ensure it does not pay out for a fraudulent claim, the investigator could be protecting the individual or individuals targeted by fraudsters from monetary and other damages. The four main types of insurance investigator jobs are claims adjuster, claims examiner, appraiser, and investigator, and they tend to be interrelated.
A claims adjuster generally works on property damage claims. To investigate the validity of a claim, he or she will look at and assess the damage to the property in question, interview the claimant and any witnesses, review any pertinent police or hospital records, and confer with experts, like physicians and lawyers, if need be. If the claim is then deemed to be legitimate, the adjuster will negotiate a settlement for the claimant.
A claims examiner typically works for health or life insurance companies. He or she may assist a claims adjuster with the investigation of information related to a specific claim or claims when the circumstances surrounding a claim are very complex. A claims examiner may be called in to investigate claims in the event of a major disaster, when people are going to claim billions in damages, like in the case of Hurricane Katrina, which took place in New Orleans, Louisiana, during 2005.
One of the most common of all insurance investigator jobs is that of appraiser. An insurance appraiser is an individual who usually goes to a site to look at damage to a property or automobile, and to interview the claimant regarding the circumstances that he or she alleges lead to the damage. The appraiser then makes a determination of the monetary value, if any, that the insurance company should offer to cover the costs of repair. If the appraiser suspects any fraud, such as a staged traffic accident or arson, he or she will report that to the insurance company so that further investigation can be carried out before paying on the claim.
Of all the different types of insurance investigator jobs, perhaps the most stressful is that of investigator. An insurance investigator is usually called in if an adjuster, examiner, or appraiser suspects that someone is making a fraudulent claim. He or she typically interviews individuals who may be related in some way to the claim, in an attempt to bring together all the facts. The investigator may undertake surveillance work related to a suspicious claim by using specialized equipment, such as a video or digital camera. For example, in the case of a suspicious worker’s compensation claim, the investigator might record someone who is actually working when they have claimed they are too physically incapacitated to do so.
While people who work in insurance investigator jobs are not usually required to have an advanced degree, many of those who do hold such positions have at least a bachelor’s degree. Many insurance companies require that those who hold investigator positions with them be licensed, however. They typically also require that those agents receive ongoing training. Automobile and property damage appraisers need the same because automobile parts, especially, and building materials and specs change from time to time. Examiners and adjusters, especially, need to keep abreast of modifications of existing insurance laws, and be aware of new rules and regulations related to the claims industry.