Claims Investigator job description
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What does a Claims Investigator do?
The Claims Investigator plays a crucial role in determining the validity of insurance claims by conducting thorough investigations. This position is essential to minimizing fraudulent claims, thereby protecting the financial resources and interests of the company.
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What are the Key Responsibilities of Claims Investigator
- Conduct detailed investigations into claims to verify accuracy and legitimacy.
- Interview claimants, witnesses, and third parties to gather pertinent information.
- Review documentation related to claims, including medical records and police reports.
- Work closely with insurance adjusters and legal team to resolve disputed claims.
- Prepare comprehensive reports summarizing investigation findings.
- Maintain up-to-date knowledge of insurance laws and regulations.
- Utilize surveillance tools and techniques when necessary.
What are the Skills and Requirements for a Claims Investigator?
- Strong analytical and problem-solving skills.
- Excellent communication and interviewing skills.
- Proficiency in investigation and surveillance techniques.
- Ability to work independently and manage multiple investigations simultaneously.
- Familiarity with legal terminology and concepts.
What are the KPIs to track for Claims Investigator?
The Claims Investigator's success is measured by the accuracy and thoroughness of investigations, reduction of fraudulent claims, and timely resolution of claims disputes.
Investigation Accuracy
Ensure accuracy in findings and elimination of fraudulent claims.
Timeliness
Complete investigations within set timeframes.
Report Quality
Produce clear and comprehensive investigation reports.
Reports to
Claims Manager
Collaborates with
Insurance Adjusters, Legal Team
Leads
N/A
Are any specific tools or software required for the Claims Investigator role?
- Surveillance Equipment
- Case Management Software
- Digital Recorders
What is the qualification of Claims Investigator?
Bachelor's degree in Criminal Justice or related field, with 3-5 years of experience in claims investigation or a related field.
