Fraud Investigator Job Description Template

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Fraud Investigator Job Description Template

Job Brief

We are looking for a talented Fraud Investigator to be responsible for identifying and handling suspicious or problematic insurance claims while providing consultation and strategic directions through professional reports.

The ideal candidate should have demonstrable analytical skills along with a passion for research and investigative evidence analysis.

Responsibilities

  • Conduct objective, fair, thorough, unbiased and timely investigations into allegations of fraud, waste or abuse committed by clients against our company
  • Review and research evidence/documents to analyze the overall fact pattern of claim and synthesize data into a professional report with recommendations
  • Prepare and coordinate field assignments to obtain relevant evidence and information
  • Coordinate with defense attorneys to provide deposition strategies and use law enforcement resources for assistance
  • Manage and prioritize a large and varied case load effectively and efficiently to achieve positive results
  • Prepare prosecution packages and restitution proposals

Requirements

  • Proven working experience in related field
  • Strong interpersonal and communication skills including the ability to interact with clients, upper management and law enforcement
  • Ingenuity and persistence to obtain case information not readily available with an eye for detail
  • Ability to work independently with minimum supervision
  • Good organisational skills needed to manage a high volume of assigned cases
  • Proficient with the insurance procedures, regulations and investigation methods
  • Hands on experience with relevant Information System
  • Display good interviewing and interrogation skills along with the capability of drafting reports
  • Honest and ethical with high levels of integrity and confidentiality
  • Willing to submit to extensive background checks and provide employment recommendations
  • BS degree in a related field (e.g. insurance studies, criminal justice, risk management) or other relevant certification preferred (e.g. Certificate of Insurance Fraud Investigator)

What does Fraud Investigator do?

On a day-to-day basis, a Fraud Investigator carries out various tasks to identify and mitigate fraudulent activities. Some of the typical activities include:

  1. Gathering Information: The investigator collects and reviews relevant data, documents, and financial records related to the suspected fraudulent activity. This may involve analyzing transaction records, bank statements, emails, and other sources of evidence.

  2. Conducting Interviews: The investigator interviews individuals related to the suspected fraudulent activity, such as employees, customers, or witnesses. They ask questions to obtain information, validate facts, and gather leads for the investigation.

  3. Analyzing Financial Data: Fraud investigators analyze financial data to identify irregularities, discrepancies, or patterns indicative of fraudulent activity. They may use tools and techniques such as data analysis software or forensic accounting methods to detect anomalies and potential fraud indicators.

  4. Researching and Reviewing Regulations: Keeping up-to-date with fraud-related laws and regulations is crucial for a fraud investigator. They research relevant legal precedents, review industry regulations, and identify any potential violations requiring further investigation.

  5. Coordinating with Stakeholders: Fraud investigators often work closely with other departments, such as legal, human resources, or law enforcement agencies. They collaborate with these stakeholders to gather additional information, share findings, and develop strategies to address the detected fraud cases.

  6. Preparing Reports: Investigators document their findings and prepare detailed investigative reports that present evidence, summarize the investigation process, and make recommendations for further action. These reports are used to communicate findings to management, legal authorities, or other relevant parties.

  7. Communicating with Management: Fraud investigators keep management informed about the progress of ongoing investigations, including significant findings, potential risks, and recommended actions. They may also provide guidance on fraud prevention strategies and train employees on fraud awareness and detection.

Overall, a fraud investigator's day-to-day activities involve a combination of analysis, gathering evidence, interviewing individuals, and collaborating with others to uncover and address fraudulent activities.