Insurance Fraud Investigator

An insurance fraud investigator typically investigates cases in which individuals seek compensation for false claims.

An insurance fraud investigator is usually the professional working for an insurance company for the purpose of making a determination about whether a claim was made falsely. Disability claims often involve an individual claiming that his or her quality of life is hindered, or bodily movement limited, due to chronic pain. The claim of chronic pain is frequently challenging for one to prove from a medical standpoint; therefore, insurance companies are at times in a bind, causing them to turn to private investigators.

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Types of Insurance Fraud

Insurance for Cars: Intentionally colliding with a car, then accusing the driver of fault; or trying to gain money for a car that has not actually been stolen.

Insurance for Health: Intentionally getting paid for health care one is not actually receiving; or filing invalid health care claims.

Insurance for Life: Intentionally claiming too much life insurance for one who is still living.

Insurance for Home: Intentionally making false damage claims.

Insurance for Worker’s Compensation: Intentionally falsifying claims for an injury.

Insurance Fraud Investigator

Types of Fraud

The insurance industry usually delineates two major forms of fraud: hard and soft.

  • Hard fraud is a case in which an individual intentionally fabricates a story for anticipated gains.
  • Soft fraud is when a person embellishes what should have been a legitimate claim.

For example, falsely claiming that your Rolls Royce was stolen from the driveway would be considered hard fraud. Soft fraud would be falsifying information on your insurance application.

Methods of an Insurance Investigation include the examples listed below. Insurance agents that have been in the business for a while learn to become well-versed in all of these areas.

  • Witness interviews
  • Claimant background check
  • Previous claims history
  • Medical reports (researching medical reports to find conflicting data, for instance)
  • Surveillance (watching the subject to perhaps witness behaviors that belie the claim)


The average salary for an insurance fraud investigator is 57,033, according to

Online Criminal Justice and Private Investigator Programs

Online Criminal Justice and Private Investigator Programs

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Choose your area of study and receive free information about programs you are interested in. Private investigators are used by law firms, law enforcement, insurance companies, as well as individuals to conduct investigations to build criminal and civil cases. A degree related to criminal justice could benefit an aspiring private investigator greatly. Request information from multiple schools to find the best program and educational opportunity for you!