What Does a Fraud Investigator Do?

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  • Written By: Mary McMahon
  • Edited By: Nancy Fann-Im
  • Last Modified Date: 10 September 2017
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    Conjecture Corporation
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A fraud investigator is an expert who evaluates the circumstances of a case of suspected fraud or suspicious behavior to determine if fraud occurred and make recommendations on which steps to take next. These professionals may work for banks, law enforcement agencies, professional organizations, or insurance companies. Some are freelancers who contract out their services on request to various employers. This work can be highly diverse and usually involves travel as well as opportunities to interact with a variety of individuals.

Companies can call upon a fraud investigator in several different situations. Sometimes a member of the public files an accusation of fraud, and the investigator may follow up on it, collecting information, interviewing witnesses, and making recommendations about whether to proceed with prosecution or punitive action. Fraud investigators working for law enforcement agencies, and attorneys general are most likely to perform this kind of investigation.

In other cases, a situation appears suspicious and a fraud investigation will be necessary to get the facts. An insurance company, for example, does not want to pay out on a fraudulent claim, and in the event a claim is false, it wants evidence it can use in court to sue the claimant for damages. The fraud investigator comes in whenever red flags suggest that there may be more to a situation than meets the eye. She evaluates internal documentation, interviews witnesses, and visits sites to collect information first hand.

The fraud investigator may have the authority to call upon other experts while assembling a case. With a false life insurance claim, for example, it may be necessary to ask a forensic pathologist to evaluate a body or medical records to provide insight into a case. The investigator may need to apply for authorization for outside consultants, or can have a budget to work with at his discretion. These parties may also be necessary in the event of a trial, as they will testify to their role in the investigation and any findings.

This work requires excellent observation and communication skills. A fraud investigator may have training and a background in law enforcement or a related field, but this is not required. Potential employers look for investigators with the capability to evaluate complex situations, discard irrelevant materials, and find unusual connections that others might miss. A deductive mind can be critical in cases where wrongdoers attempt to conceal evidence of a fraud to make it harder to investigate.

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ceilingcat
Post 3

I think insurance fraud investigations would be a good career for a naturally curious person. I mean, think about. You get to investigate all the little details of a certain event and find out everything there is to know about it.

I actually know someone who is a fraud investigator, and from what I hear, the salary is pretty OK too. I have a friend who did this job a few years ago and from what she told me the average fraud investigator makes around $50,000 per year. Obviously the salary varies a bit for freelancers, because they might not have work all the time.

starrynight
Post 2

@indemnifyme - Interesting.

I used to work for an insurance agency, and the insurance company we were with had insurance fraud investigators. It's pretty surprising how often people try to commit insurance fraud.

However, fraud investigators are really good at finding things out. At the company I used to work for, if a claims person thought a claim was suspicious, that would pass it on the a fraud investigator. Then it was the fraud investigators job to figure out if it was fraudulent or not.

From what I heard, a pretty significant number of claims are investigated for fraud. As the article said, insurance companies really don't want to pay out money for claims. If they can avoid it, they will!

indemnifyme
Post 1

One of my cousins is a private investigator, and he's done a few fraud investigation jobs. Usually he works for companies that are too small to have their own fraud investigation division, like a local bank or very small insurance company.

People are awfully sneaky, but fraud investigators are infinitely sneakier. From what my cousin told me, it's really not hard to get information about people if you ask the right way. For example, in the suburbs neighbors will almost always talk to you!

And of course, a lot can be found out by simply following the person suspected of fraud. You know, someone who was supposedly injured in a car accident and can't work gets caught doing a back flip or something like that?

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