Banking, Finance & Insurance

 

Insurance claims investigators evaluate insurance claims. They decide if the claim is valid, and how much the insurance company will pay.

An insurance claims investigator’s primary responsibility is to verify if the insurance claim that a client submits is valid and if so, how much the insurance company will pay to them. First of all, the insurance claims investigator needs to review the claim and any relevant documents to understand what degree of insurance coverage the person making the claim has. Then, depending on the situation, insurance claims investigators have several options to consider. They inspect the damage to property and make an assessment on the severity of it, calculating an estimate of the damages. They may interview or write to claimants, any witnesses, emergency services and medical professionals to determine events and whether there’ll be a claim settlement, further review or if the claim is denied. Or possibly examine police reports, damage to property, healthcare treatment and bills to decide up the degree of liability. Insurance claims investigators need to check every angle and perspective regarding the insurance claims to ensure that the claim request is not fraudulent. Once all details are verified and the claim is deemed valid, the claims investigator negotiates the financial settlement. If a settlement sum cannot be reached, the claims investigator recommends what legal options there are.
   

ANZSCO ID: 599611

Alternative names: Corporate Claims Analyst, Fire Investigator, Forensic Engineer, Forensic Accountant, Special Investigator, Construction Claims Analyst, Forensic Analyst, Field Investigations, Independent Investigator and Fraud Examiner

 

Knowledge, skills and attributes     

An insurance claims investigator has a difficult role. Keen attention to detail is very important, whilst examining all the data gathered. You also need good interview and investigative skills coupled with effective communication to get the facts accurately from people. Once all the information is gathered, investigators must assess and decide whether the claim is valid or not. You need sound judgement and good decision-making skills for this part. Finally, once a claim is deemed valid, then the settlement must be calculated, therefore an aptitude for numbers and calculations is important for this role.

To become an insurance claims investigator, you would need:

• an aptitude for numbers and calculations
• investigative and interviewing skills
• sound judgement
• attention to detail
• good communication skills

      

Meet a Claims Investigator in the Insurance Industry
https://youtu.be/jfrE0X9wqc8

Duties and Tasks

As an insurance claims investigator, you would:

• examine claims forms and other records to determine insurance coverage

• investigate and assess damage to property and create or review property damage estimates

• interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review

• review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability

• negotiate claim settlements and recommend legal options when settlement cannot be negotiated

• analyse the information gathered, and report findings and recommendations

• examines scenes of incidents resulting in insurance claims to determine causes and effects

• interviews witnesses and claimants to obtain details required to assess the validity of claims and identify the parties responsible for accidents, damage and loss, and prepare statements and reports

• estimate business losses due to fire, flood, theft, accidents and other business disruptions

• in some cases and depending on insurance policies, source replacement goods (new or used)

• assess compliance with policy in regard to security and customer obligations

• inspect accident scenes and other incidents to determine causes and effects

• interview the person making the claim to obtain the information required to assess the validity of the claim
  

(Source: CareerHQ)

 

Working conditions

In a full-time job you would work standard hours, Monday to Friday. You would often work outside the office, inspecting property that was the subject of insurance claims, such as damaged buildings and vehicles. You would need to drive to the claimant's location or the location of an incident, so would need a current drivers' licence.

 

Education and training/entrance requirements

A senior secondary school certificate or equivalent is typically required to work as an entry-level insurance investigator. In addition, you would need insurance-related work experience.

Increasingly, these types of roles require a bachelor’s degree and/or professional industry training. 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.

 

(Source: CareerHQ)

 

Employment Opportunities

As the number of vehicles increases, the number of insurance claims is also likely to increase. Demand for insurance claims investigators in property and casualty insurance is influenced by the number of natural disasters, such as floods and fires. Insurance officers in these areas may see strong employment growth as the number of natural disasters increases.

These factors will be somewhat offset by automation. Technology allows less complex claims to be processed automatically, which frees investigators to work on more complex claims. This means that fewer investigators are needed per claim, reducing the overall number of investigators.

 

 

 

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Material sourced from
Web Archive Only - CareerHQ [Insurance Claims Investigator; Blog; ]
The Good Universities Guide [Insurance Investigator; ]
Career Connections [Claims Investigator; ]
  Your Career [Insurance Investigator; ]