Insurance Fraud Investigator Requirements

November 12, 2020 Post a Comment

Insurance fraud can be related to auto insurance workers compensation claims medical insurance home-owner insurance and life insurance policies. Fraud investigators must work independently and have precise written and verbal communication skills.

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The Certified Insurance Fraud Investigator CIFI program is an accrediting process for individuals with the specialized skills required to detect investigate and deter insurance fraud.

Insurance fraud investigator requirements. Arson and Insurance Fraud Reporting. Insurance fraud investigators can qualify for optional certification as Certified Fraud Investigator through the International Association of Special Investigation Units. The common thread is that fraud revolves around a purposeful misrepresentation of fact to an insurer to gain an unearned benefit.

Unemployment Insurance Identity Theft Fraud. The insurance Fraud Prevention Act of 1994 set for a legal basis for federal involvement. Bureau of Labor Statistics BLS wwwblsgov this career does not require formal education beyond a high school diploma but insurance companies often seek investigators with training in law enforcement private investigation or insurance claims.

To become an insurance fraud investigator you must usually obtain a college degree and devote years to gaining experience and learning the trade at an insurance company. The Plan must include the name title job description and geographical location of each investigator in the SIU. In any case federal government should play a leading role in assisting the state government and insurance industry in detecting insurance fraud.

A minimum of a high school diploma or equivalent is generally needed to become a fraud investigator. Graduates with a background in private investigation criminal justice or insurance are qualified to become certified through the IASIU as a Certified Insurance Fraud Investigator. Notice 2017-10 found here.

The Certified Insurance Fraud Analyst CIFA program is an accrediting process that covers all topics that deem an analyst to be well rounded and versed in all. Additionally the qualifications of potential fraud investigators include the ability to conduct interviews write legal reports take statements and collect organize document and preserve evidence. An insurance fraud investigator is employed when a false claim is suspected.

Before you start your insurance fraud investigation figure out the who what where when and how of the case. To become certified you. Five 5 years of experience investigating financial fraud internal affairs healthcare fraud insurance fraud or complex investigations required.

Insurance investigators are required to have a high school diploma and they may be required to be licensed or certified. According to the US. An insurance fraud investigator analyzes and investigates fraud in all types of insurance including property automobile medical and workers compensation.

Conduct an Initial Assessment. Overview of Insurance Fraud Investigators. The program has a high standard for admission and testing which includes adherence to IASIUs code of ethics and a demonstrated competency through mandatory continuing professional education.

Identity thieves and hackers have long known how to use stolen identities to commit fraud for example to open a new credit card or file a false tax return and criminals using stolen identities to defraud public assistance programs is not new. Check your states laws on pretext investigations and when in doubt conduct your insurance fraud investigation in an honest and open manner. Initially federal government was interested in controlling health care costs and fighting health insurance fraud.

Many organizations provide on-the-job training to insurance investigators after they are hired. If the fraud is related to financial losses an investigator might be required to have an accounting background or experience. Other requirements vary by state.

Insurance fraud investigators need to be honest detail-oriented and quick thinking. The Certified Insurance Fraud Investigator CIFI program is an accrediting process for individuals with the specialized skills required to detect investigate and deter insurance fraud. Insurers must demonstrate that investigators meet the specific education or experience qualifications specified by Section 409 b 3 and Regulation 95 866 c.

Special Market Notice regarding Insurance Fraud Investigations issued 7142017 Insurance companies are responsible for reporting suspected fraud. A background in law enforcement insurance claims or firefighting may be. Individuals who have earned a bachelors degree in criminal justice economic crime fraud management accounting law or business administration are typically the most sought-after and highly-qualified candidates.

The requirements are clarified in the Pennsylvania Bulletin.

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