What is a Claims Investigator? What Does a Claims Investigator Do? #161

What is a claim investigator? An Insurance claims investigator has a variety of duties and tasks as it pertains to insurance claims.  There are claims investigators that work for insurance companies or third party administrators as employees while other times the insurance companies contract the work out to investigative companies.’

An insurance claim investigator’s duties at its core are the same as a private investigator.  An insurance claim investigator’s duty is to collect information.  

Before I get into the basic things that a claims investigator does, I thought it only fitting to share the industry outlook for this occupation should you be interested.

Industry Outlook for Insurance Claims Investigators

The industry outlook doesn’t seem to be growing very fast as the Bureau of Labor and Statistics believe there will only be a 3% increase in the Claim Investigator occupation from 2014 to 2016 with a positive increase of 9,600 during that time.  I believe that is a very small increase nationwide over 10 years.  

The approximate number of employed in the industry (Claims Adjusters, Appraisers, Examiners, and Investigators) was 315,300 in 2014.  



Education Level for a Claims Investigator

An entry level claims investigator might only need a high school diploma when applying for investigation companies.  Many investigation companies that work files will say they are looking for applicants with degrees but it is not critical to being hired.  I have discussed how to find a private investigator job in the past which will help you be a claims investigator as well.

Having a degree will help an individual get hired with an insurance company.  Typically a Bachelor’s degree is a minimum requirement for insurance companies in the claims department.

Why an Insurance Claim Investigator is Assigned

The claim adjuster/examiner will assign an assignment regarding a claim for a variety of reasons.  Sometimes it is to locate more information and sometimes it can be a bit more than that (concerns of insurance fraud).  Below are some of the types of assignments a claims investigator might receive.

Locating a Claimant or an Insured

There are instances where a claimant or an insured has gone missing in action after a claim has been filed. The insurance company wants to speak with the individual but they go out of their way to not be found or to participate in the insurance claim process.  Investigators will locate the individual if possible and attempt to secure information critical to the claim process.

Interviewing an Insured, Claimant or Witnesses

Interviewing a claimant and or an insured is quite common in the insurance industry to find out more information regarding a claim.  Insurance claims can be very complicated, complex and have many different pieces involved that need to be addressed and then presented in a manner that is clear for the insurance company to understand.

Once this is done it can help the insurance company come to a decision on how they would like to move forward with an insurance claim.

Claims investigator interviewing a claimant

Locating Witnesses

Witnesses can be critical to insurance claims as they can be a verifiable source as to how something took place.  Investigators are sometimes tasked with finding witnesses and sometimes witnesses are developed.

There are times where it is easy to identify witnesses to an accident or incident regarding an insurance claim. Witnesses can be developed through interviews with the insured or the claimant.  Sometimes investigators canvass a neighbor and speak to anyone in the area where an accident took place, and other times witnesses are identified in police reports.

Photographing an Accident Area

Insurance claims investigators are sometimes tasked with photographing an incident area.  It might be an intersection where an accident took place or where someone fell and hurt themselves.  

Photographs provide context to insurance claims and help insurance companies determine liability, fraud or if someone was negligent.

Investigators can also be tasked with photographing vehicle damage as well.

There are endless scenarios where a claims investigator may be asked to photograph or even videotape to provide them more information about a claim.

Photographing an area is quite common as a claims investigator.

Taking Measurements (Misc Items, Vehicles, Locations)

Taking measurements and photography typically go hand in hand in my experience.   As a claims investigator, I have been tasked with measuring anything possibly relevant to an insurance claim.  And then after measuring a claims investigator might be tasked with creating a diagram to explain how an incident happened.

Photographing measurements is just as important as photographing a scene of an accident in many cases. Photographs show an insurance company what is being measured and what the distance is of that measurement.

Claims investigator measuring a window

Confronting an Insured or a Claimant Regarding a Claim

There are cases where the insurance company already has evidence of fraud.  They then ask a claims investigator to confront the claimant or the insured of the fraud.

These can be hostile (by the insurance or claimant), difficult conversations to have and personally are not my favorite.  Many times these types of conversations result in a claim being dropped by the end of a confronting conversation with a claims investigator.

Conducting Disability Benefit Interviews

When an insured becomes ill to the point where they can no longer work insurance companies will send a claims investigator to interview them regarding their claim.  This is very much about information collecting to find out information about doctors and the reason for filing for disability insurance.

The interviews are typically non-recorded interviews and there is a significant amount of note writing on behalf of the investigator.

Locating Additional Evidence Critical to an Insurance Claim

Locating any evidence that either proves or disproves a claim is important for an insurance company.  Insurance companies are not out to disprove every claim made.  They do want to pay on valid legitimate claims.

Claims Investigators are like Private Investigators

Final Thoughts

Although I separated each objective many times all of these objectives are integrated into one assignment.  An interview can uncover a witness and a witness can uncover additional evidence.  

Claims investigators are information collectors and are vital when it comes to collecting information for insurance companies to provide a clear (or clearer) picture of an insurance claim.

Being a claims investigator can be very rewarding and is definitely a line of work that private investigators should consider.

Andrew



3 comments

  1. I have a question in that, what field can an individual pursue, if he or she is unable to obtain a license because of their past involvement with authorities ie: DWI,