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?

Do the following statements accurately describe you?

You are currently enrolled in a science, accounting, computer science, engineering, law enforcement or criminal justice program at the post-secondary level
You have exceptional interpersonal skills and are naturally inquisitive
You have a sense of mutual respect and fairness and highly value ethical behaviour
You have good decision-making skills and work well within a team
You have a reputation beyond reproach, with a keen interest in civil law, insurance law, rules of evidence and procedure

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

How do I get there?

Claims investigation is a specialized field requiring a blend of interpersonal and technical skills. For this reason, a degree is less important than an ability to display the competencies and development potential to become an effective claims investigator. Exceptional communication, empathy and investigative skills are essential.

For a highly specialized role such as a forensic engineer or forensic accountant, a degree is essential to gain employment in this field.

A combination of the following qualifications would be helpful as a claims investigator in the property and casualty insurance industry.

College/University

Technical skills can be learned through a college diploma in law enforcement, criminal justice and/or business of insurance program.

For a highly specialized role in forensic accounting, forensic engineering or accident re-constructing, a university degree in engineering or accounting is required along with a certified public accountant designation (ie CMA, CA, CGA) or a professional engineer designation (ie PEng)

Professional Qualifications

For those interested in an investigations career, certifications in fraud examination are available through 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.