In general, fraud investigators work to determine whether individuals or organizations have attempted deception to realize a financial benefit. Fraud investigation applications are numerous, and so fraud investigators typically specialize in a particular field, such as insurance or accounting. The vast majority of fraud investigator work within the field of insurance, due to the high inherent potential for insurance fraud and the volume of fraud cases that occur annually.
No matter the particular field, the primary duties of fraud investigators involve examining evidence, performing data analysis and interviewing involved parties in an effort to determine whether an attempt at fraud has occurred. In the insurance industry, where most fraud investigators work, the typical case begins with an informant’s tip or a flag triggered by automatic computer analysis of insurance claims. The investigator then opens the case to determine whether the individual has staged events for a claim or has requested compensation for unnecessary claims.
To enter the field of fraud investigation, individuals generally must possess a high school diploma or equivalent; however, companies usually give hiring preference to applicants with related experience or college-level education. In terms of work history, employers view former police officers, private investigators, and insurance adjusters favorably, as these roles are associated with interviewing and evidence analysis skills. Correspondingly, fraud investigators must be both analytically minded and excellent communicators with strong verbal abilities.
Fraud investigators typically work regular business hours in an office environment, especially within the financial or insurance fields. However, some amount of fieldwork is often necessary, and investigators are occasionally required to stand as witnesses in court.
Fraud Investigator Tasks
Perform desk and on-site investigational audits.
Develop, perform, and present fraud cases.
Research records and obtain, analyze, and appraise evidentiary data.
Investigate fraud by obtaining statements of fact, depositions or confessions from complainants, employers and witnesses.
Oversee the development and implementation of fraud prevention, detection and resolution strategies.