Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vivamus convallis sem tellus, vitae egestas felis vestibule ut.

Error message details.

Reuse Permissions

Request permission to republish or redistribute SHRM content and materials.

Insurance Fraud Investigator

Job Summary:

The Insurance Fraud Investigator will investigate possible cases of insurance fraud, assemble evidence to build a case, and then recommend further action to the appropriate enforcement and compliance officers.

Supervisory Responsibilities:

  • May participate in hiring and interview process for potential fraud investigators.


  • Interviews key witnesses to gather initial information regarding suspicions of fraudulent claims, inconsistent behavior, and other supporting evidence.
  • Identifies appropriate investigative steps, which may include conducting field investigations, surveillance, and interviews.
  • Gathers evidence and information; determines whether initial evidence is sufficient to establish a claim and build a case.
  • Prepares regular case status and progress reports for supervisor; recommends pursuit of further investigation or conclusion of case.
  • Manages the case until resolved.
  • Maintains required records and documentation.
  • Collaborates with civil authorities, contacts at insurance information bureaus, and other investigators as needed to build and support developing cases.
  • Develops and presents, or assists with, fraud detection training and educational programs.
  • Performs other related duties as requested.

Required Skills/Abilities:

  • Basic understanding of human behavior and performance.
  • Basic understanding of relevant equipment, policies, procedures, and strategies to conduct investigations and to promote security operations.
  • Ability to identify discrepancies and problems.
  • Excellent verbal and written communication skills.
  • Thorough understanding of laws related to insurance fraud.
  • Proficient in Microsoft Office Suite or related software.

Education and Experience:

  • Bachelors degree required; coursework in related areas such as criminal justice or psychology preferred.
  • Former police or investigative experience required; detective experience highly preferred.

Physical Requirements:

  • Prolonged periods sitting at a desk and working on a computer.
  • Must be able to lift up to 15 pounds at times.
  • Must be able to travel and access various areas in the course of investigations.


​An organization run by AI is not a futuristic concept. Such technology is already a part of many workplaces and will continue to shape the labor market and HR. Here's how employers and employees can successfully manage generative AI and other AI-powered systems.