---
name: insurance-fraud-investigator
description: "Occupational skill for the role 'insurance fraud investigator' (also: insurance fraud auditor, insurance policy processing worker, insurance auditors, insurance fraud examiner, insurance fraud inspector). Use when the user asks for typical insurance fraud investigator work such as: Maintain knowledge of current events and trends in such areas as money laundering and criminal tools and techniques.; Train others in fraud detection and prevention techniques.; Research or evaluate new technologies for use in fraud detection systems."
---

# Insurance Fraud Investigator

Insurance fraud investigators combat fraudulent activities by investigating the circumstances of certain suspicious claims, activities related to new customers, buying insurance products and premium calculations. Insurance fraud investigators refer potential fraud claims to insurance investigators who then undertake research and investigations to support or deny a claimant's case.

## Core workflow

1. Maintain knowledge of current events and trends in such areas as money laundering and criminal tools and techniques.
2. Train others in fraud detection and prevention techniques.
3. Research or evaluate new technologies for use in fraud detection systems.
4. Prepare evidence for presentation in court.
5. Negotiate with responsible parties to arrange for recovery of losses due to fraud.
6. Conduct field surveillance to gather case-related information.
7. Testify in court regarding investigation findings.
8. Advise businesses or agencies on ways to improve fraud detection.

## How to use this skill

- Read [references/profile.md](references/profile.md) for the occupation profile and scope.
- Consult [references/tasks.md](references/tasks.md) for the full task and activity inventory.
- Check [references/skills.md](references/skills.md) for essential vs. optional competences.
- Check [references/tools.md](references/tools.md) for the software commonly used in this role.
- See [references/ai-skills.md](references/ai-skills.md) — matched external AI agent skills (per-source attribution).

## Key competences (essential)

- actuarial science
- analyse claim files
- assess customer credibility
- assist police investigations
- claims procedures
- conduct financial audits
- detect financial crime
- fraud detection
- insurance law
- interview insurance claimants
- principles of insurance
- review insurance process
- types of insurance

## Hot technologies

- SAS
- Tableau
- Splunk Enterprise
- Microsoft Access
- Microsoft SQL Server
- Structured query language SQL
- Microsoft SharePoint
- Microsoft Outlook
- Python
- R

---
*Sources: ESCO v1.2.1 (http://data.europa.eu/esco/occupation/a2b81132-2147-4c8e-b250-e6290ed906ea), O*NET 30.3 (13-2099.04). See manifest.json for licensing/attribution.*