What does a claim investigator do?
Claim Investigators are professionals who are responsible for examining facts of insurance claims to determine their extent and validity to prevent any cases of fraud. These investigators must use a combination of tools such as cutting-edge software to help insurance companies to settle claims quickly by evaluating them. They are required to manage multiple cases by investigating defective products or events such as an oil spill. Claim Investigators must also prepare reports while keeping track of evidence trails.
Claim investigator responsibilities
Here are examples of responsibilities from real claim investigator resumes:
- Manage and dispose of claims in litigation by preparing and developing strategy with defense counsel and consensus relative to litigation handling.
- Coordinate with SIU investigators in their investigations of the same claimant or insure.
- Collaborate with SIU, fire, and police personnel in an effort to resolve investigations.
- Conduct extensive field investigations and interact with staff attorneys on litigation matters.
- Prepare and/or review property and content estimates for settlement using Xactimate and XactContents software programs.
- Conduct complete assessment of interior and exterior damage to create a detail repair estimate within Xactimate software.
- Analyze high risk transaction activity and provide final approval of investigative case analyses utilize for SAR preparation and filing.
- Prepare sworn affidavits, subpoenas and other legal documents.
- Prepare cases for hearing, testify in administrative/criminal hearings, requested/serve subpoenas.
Claim investigator skills and personality traits
We calculated that 11% of Claim Investigators are proficient in Scene Investigations, Insurance Claims, and Property Damage. They’re also known for soft skills such as Analytical skills, Detail oriented, and Interpersonal skills.
We break down the percentage of Claim Investigators that have these skills listed on their resume here:
- Scene Investigations, 11%
Secured written/recorded statements, accident scene investigations, and produced accurate, detailed reports.
- Insurance Claims, 7%
Engaged in the investigation of suspicious insurance claims including, disability, general liability, automobile and vessel damage.
- Property Damage, 5%
Evaluated property damage claims for legitimacy relative to terms of coverage interpretations; provided property value estimates, in applicable cases.
- Fraud Claims, 5%
Selected as part of the SIU (special investigations unit) team to process and review theft and fraud claims.
- Background Checks, 5%
Assisted in developing a special investigation unit by developing a due diligence process to conduct background checks on employees and applicants.
- Litigation, 4%
Collaborated with in-house attorneys and Special Investigation Unit to gather information for litigation purposes.
"scene investigations," "insurance claims," and "property damage" are among the most common skills that claim investigators use at work. You can find even more claim investigator responsibilities below, including:
Analytical skills. To carry out their duties, the most important skill for a claim investigator to have is analytical skills. Their role and responsibilities require that "adjusters and examiners must each evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay." Claim investigators often use analytical skills in their day-to-day job, as shown by this real resume: "provide litigation support to legal counsel that includes data gathering, participation in mediations, settlement conferences, and court proceedings. "
Detail oriented. Another essential skill to perform claim investigator duties is detail oriented. Claim investigators responsibilities require that "adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences." Claim investigators also use detail oriented in their role according to a real resume snippet: "composed comprehensive detailed captions reports to company adjuster, defense counsel, business owner's. "
Interpersonal skills. Another skill that relates to the job responsibilities of claim investigators is interpersonal skills. This skill is critical to many everyday claim investigator duties, as "adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering." This example from a resume shows how this skill is used: "maintained excellent interpersonal communication skills that further enhanced my proven creative problem solving capabilities. "
Communication skills. Another crucial skill for a claim investigator to carry out their responsibilities is "communication skills." A big part of what claim investigators relies on this skill, since "claims adjusters and investigators must get information from a range of people, including claimants, witnesses, and medical experts." How this skill relates to claim investigator duties can be seen in an example from a claim investigator resume snippet: "demonstrated highly effective written and oral communication skills with all investigative reports, meeting or exceeding performance objectives. "
The three companies that hire the most claim investigators are:
- CoventBridge Group36 claim investigators jobs
- Allied Solutions3 claim investigators jobs
- First Horizon Bank2 claim investigators jobs
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Compare different claim investigators
Claim investigator vs. Fraud analyst
Fraud analysts are responsible for monitoring bank accounts, accounting paperwork, and financial transactions. They analyze the data to identify any fraudulent and suspicious activities within an organization. Their duties and responsibilities may vary depending on which industries they work in. These may include keeping the confidentiality of any collected information, resolving customers' problems, and maintaining fraud analysis models to enhance the effectiveness and efficiency of company systems. Fraud analysts are also expected to provide recommendations for anti-fraud processes and new software tools to improve fraud detection and prevention.
There are some key differences in the responsibilities of each position. For example, claim investigator responsibilities require skills like "scene investigations," "insurance claims," "property damage," and "background checks." Meanwhile a typical fraud analyst has skills in areas such as "customer service," "fraud prevention," "sql," and "fraudulent transactions." This difference in skills reveals the differences in what each career does.
Fraud analysts really shine in the finance industry with an average salary of $62,728. Comparatively, claim investigators tend to make the most money in the finance industry with an average salary of $56,935.On average, fraud analysts reach similar levels of education than claim investigators. Fraud analysts are 1.5% less likely to earn a Master's Degree and 1.3% less likely to graduate with a Doctoral Degree.Claim investigator vs. Subrogation specialist
Typically working for insurance companies, a property adjuster specializes in inspecting property damages to assess and determine a company's financial obligations. Their responsibilities revolve around reaching out to clients through calls and correspondence, arranging appointments, gathering and verifying data, and traveling to different locations to meet with clients. They may also negotiate settlements and authorize payments in adherence to the company's policies and regulations. Furthermore, as a property adjuster, it is essential to have a deep understanding of property costs to ensure the accuracy of claims.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that claim investigator responsibilities requires skills like "scene investigations," "property damage," "fraud claims," and "background checks." But a subrogation specialist might use other skills in their typical duties, such as, "subrogation claims," "workers compensation," "potential recovery," and "payment arrangements."
In general, subrogation specialists achieve similar levels of education than claim investigators. They're 1.8% less likely to obtain a Master's Degree while being 1.3% more likely to earn a Doctoral Degree.What technology do you think will become more important and prevalent for claim investigators in the next 3-5 years?
John Lajoie CLI
National Director, President of Lajoie Investigations, Inc, of MA, NALI - National Association of Legal Investigators
Claim investigator vs. Property adjuster
An adjuster is responsible for evaluating the extent of loss in the company by calculating the damage costs, determining the settlement payment to the client, and managing the reputation of the company for claims accountability. Adjusters must have extensive knowledge of the insurance principles and processes, following the state and federal regulations to protect clients and the business from insurance fraud. They collect documents from different organizations, perform field research, and interview witnesses to verify the accuracy of claims statement.
The required skills of the two careers differ considerably. For example, claim investigators are more likely to have skills like "scene investigations," "property damage," "fraud claims," and "background checks." But a property adjuster is more likely to have skills like "customer service," "xactimate," "ladders," and "state regulations."
Property adjusters earn the best pay in the insurance industry, where they command an average salary of $58,634. Claim investigators earn the highest pay from the finance industry, with an average salary of $56,935.Most property adjusters achieve a similar degree level compared to claim investigators. For example, they're 0.7% less likely to graduate with a Master's Degree, and 0.6% less likely to earn a Doctoral Degree.Claim investigator vs. Adjuster
Types of claim investigator
Updated January 8, 2025
