Almost everyone today carries different insurance policy types.
Businesses will typically have insurance policies on their properties and other assets. While individuals usually avail of health, car, life, and home insurance policies. Of course, these insurance policies are meant to be claimed should there be an incident that warrants it. However, not all claims are actually made in good faith that’s why fighting insurance fraud is also a big part of criminal justice.
Insurance claim fraud has largely been a rampant occurrence in the insurance industry.There have been many occurrences where people tried to profit by making false claims on their policies. The Insurance Research Council published in their study that as much as 21% to 36% of auto claims are deemed to be fraudulent. Relatedly, the National Insurance Crime Bureau calculates roughly that more than $5 billion in fraudulent compensation claims are lodged annually.
Job Duties and Responsibilities
Due to the aforementioned reasons, insurance companies typically hire a team of insurance fraud agents who are tasked to examine and investigate suspicious claims. This is because insurance fraud cost the industry billions of dollars in duplicitous payouts. The most likely targets for fraud in the past have been property and casualty insurance companies.
This has been one of the reasons why insurance for certain products has become so high. The company is not just charging you to insure your property. They also have to recoup the cost it requires to detect and go after fraud.
In this way, an insurance fraud agent can be similar to a detective or private investigator. Their job involve looking for evidence that either a person or business has intentionally defrauded the insurance company. Agents usually utilize computers and databases to carry out exhaustive background checks. They also use a number of surveillance methods to track the actions of specific people. Also included in their duties are conducting interviews with colleagues, neighbors, family, and relatives of the suspect to further get information. A lot of these agents are called to testify if the claim is contested in court.
How Insurance Agents Investigate
Workman’s compensation claim is a common type of insurance fraud. This is when people overstate the extent or impact of an injury on their ability to work or emotional and mental well-being. Individuals are not the only one guilty of this type of fraud. Doctors, hospitals, as well as even insurance companies themselves have made such fraudulent claims in the past.
Many try to deceive the system for financial gain. Insurance agents monitor for any red flags and after which, they begin an investigation. An agent may follow the claimant in undercover so as to verify the veracity of the extent his or her injuries. If ever he finds an invalid claim in the process, the agent can then file a case against the claimant.
Vehicular accidents are typical breeding grounds for this type of insurance fraud. People often claim head and neck injuries even if they’re okay. In worst cases, some even stage accidents so they can file a claim. If an insurance fraud agent’s surveillance prove these claims to be false, claimants who tried to make dishonorable claims can be tried for fraud.
Education, Licenses, and Certifications
There is no one degree required to be an insurance fraud agent. A GED or high school diploma is often the minimum. However, most insurance companies will demand candidates with at least an associate’s or bachelor’s degree. Prior experience working in similar or related criminal justice jobs is also a huge advantage for the job.
Additionally, you can also take certifications that can help boost your credentials. For instance, the International Association of Special Investigation Units (IASU) offers a Certified Fraud Investigator program. The program allows you to improve your investigative and deductive, which are two critical skills required for the job. To enroll, you must be a college graduate and have enough experience working in the field.
Numerous states also require a license to perform investigations. Each state typically has its own mandates, such as meeting minimum educational requirements. Most also require succeeding a background check and acing a written test.
Job Outlook, Salary Potential, and Location
The U.S. Bureau of Labor Statistics states that job growth in the next few years for insurance fraud agents is likely minimal. This is despite the fact that the number of fraudulent claims is bound to increase. This is because technology is expected to help minimize the amount of time agents spend doing research and background checks.
The federal government approximates that the average salary for fraud agents is at $55,760. Aside from receiving a monthly salary, agents are reimbursed for any expenses incurred during investigations.
Competition is stiff in these jobs and many former military and law enforcement professionals vie for this work. Insurance fraud agent positions are found all over the country, not just with insurance agencies and companies, but with federal and local government as well.