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Become A Fraud Investigator

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Working As A Fraud Investigator

  • Getting Information
  • Identifying Objects, Actions, and Events
  • Documenting/Recording Information
  • Interacting With Computers
  • Making Decisions and Solving Problems
  • Mostly Sitting

  • Make Decisions

  • Stressful

  • $45,610

    Average Salary

What Does A Fraud Investigator Do At Kelly Services

* Reviews, assesses, and prioritizes referrals to the Special Investigations Unit.
* Develops investigative action plans.
* Investigates multiple types of cases, including internal fraud, employee misconduct, claims fraud, agent related fraud and complex cases with multiple insured’s.
* Functions as lead investigator on large investigations and special projects
* Assists Departments of Insurance and law enforcement agencies with investigations of fraud and agent misconduct.
* Consults with business partners, Departments of Insurance, Law Enforcement, and other agencies to provide training guidance, and investigate and report fraud as required.
* Writes investigative reports and communicates risks and trends from fraudulent activities

What Does A Fraud Investigator Do At Travelers

* Analyzes and summarizes highly technical information related to multiple complex case investigations with regional and national implications.
* Conducts thorough and timely complex field investigations while managing resources with a focus on uncovering potential fraudulent medical aspects of a claim.
* Applies the techniques of critical thinking to prioritizes and develop medical investigations that have complex allegations and/or significantly financial impact to multiple claims and/or organized ring activity spanning across multiple lines of business and potentially across several states.
* Makes key decisions regarding the structure and organization of major medical case investigations involving multiple claims and/or organized ring activity with regional and national implications.
* Provides exceptional customer service by maintaining contact with business partners, customers and external resources throughout the life of each investigation.
* Acts as a liaison with local/state/federal law enforcement personnel, industry advocates and other companies Serves as the subject matter expert (liaison) on medical fraud to business and industry partners.
* Applies rules of evidence; recognizes evidence and determines its value to specific claim, evidence collection and interpretation.
* Establishes and maintains a professional network in the medical anti-fraud industry (e.g., National Insurance Crime Bureau, National Healthcare Anti
* Fraud Association, local fraud agencies, law enforcement, etc.).
* Identifies cases for potential insurance fraud prosecution and submits questionable claims to the National Insurance Crime Bureau.
* Analyzes, transforms and conveys emerging trends in the medical fraud arena into actionable investigative strategies.
* Proactively collaborates with supporting business partners (e.g., claim, legal, nurses, analytical unit etc.) to implement anti-fraud and medical defense strategies.
* Responsible for strengthening technical capabilities within claim to identify potential medical fraud.
* Assists in the identification and communication of trends to manager of the program.
* Conducts post-mortems on cases closed or status reviews of cases in progress.
* Prepares and conducts technical training in detecting and applying techniques to multiple medical complex cases.
* Testifies to findings.
* Other duties as assigned.
* Job Opening ID:
* BR
* Environmental/Work Schedules/Other:
* Work Schedules Overnight work hours: Occasionally.
* Other Travel: Frequently.
* Incumbents who fill this position will be subject to periodic post-hire criminal background checks while employed in this position.
* As a condition of acceptance for the position, selected candidates for this position will be required to electronically accept the Fair Credit Reporting Act (FCRA) Disclosure Statement and Authorization included in the online employment application.
* You may also be subsequently asked to accept similar FCRA authorizations periodically throughout your employment with the Company.
* Equal Employment Opportunity Statement:
* Travelers is an equal opportunity employer

What Does A Fraud Investigator Do At Old National Bank

* Review and investigate suspicious activity as derived from the variety of reports.
* Investigate assigned cases at various risk levels as an expert analyst and interviewer.
* Ensure that all investigations are handled in an efficient and timely manner to meet all regulatory guidelines and requirements.
* Maintain a role in the preparation of Suspicious Activity Reports and provide supporting documentation with the filing requirements of FinCEN.
* Represent the corporation to local, state and federal law enforcement agencies as needed

What Does A Fraud Investigator Do At Louisiana Department of State Civil Service

* JOB TITLE. NOT ALL POSSIBLE TASKS ARE INCLUDED.
* Conducts criminal investigations involving the fraudulent procurement of monies, goods, or services through programs administered by DCFS.
* Assists in investigations of agency personnel suspected of employment related criminal misconduct and violations of agency, departmental, or State Civil Service personnel policies.
* Works with similar investigative units in state and federal law enforcement agencies.
* Serves documentary evidence from private concerns and governmental agencies.
* Deposes witnesses and interrogates suspects; secures physical evidence and handwriting specimens for analysis.
* Prepares comprehensive investigative and programmatic financial loss reports for use in criminal, administrative, and disciplinary action proceedings.
* Files criminal charges, serves as agency liaison, and acts as chief witness in related criminal, administrative, and disciplinary action proceedings.
* Performs pre- and post-adjudication activities including, but not limited to, locating fugitives, securing restitution, executing programmatic disqualification instruments and conferring with Department of Corrections' personnel on pre-sentence and probation revocation proceedings.
* Prepares detailed cost allocation statistical reports on work performed which are compiled at the state-office level and used to determine appropriate federal matching

What Does A Fraud Investigator Do At NCI

* Conducts independent investigations resulting from the discovery of situations that potentially involve fraud, waste, or abuse.
* Utilizes data analysis techniques to detect aberrancies in Medicare claims data, and proactively seeks out and develops leads received from a variety of sources (e.g., CMS, OIG, fraud alerts).
* Completes written referrals to law enforcement and takes steps to initiate recoupment of overpaid monies.
* Responds to requests for information from law enforcement.
* Maintains cases that were referred to law enforcement.
* Maintains the "Do not pursue" list.
* Reviews information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare policies and initiates appropriate action.
* Makes potential fraud determinations by utilizing a variety of sources such as the UPIC's internal guidelines, Medicare provider manuals, Medicare regulations, and the Social Security Act.
* Develops and prepares potential Fraud Alerts and Program Vulnerabilities for submission to CMS; shares information on current fraud investigations with other Medicare contractors, law enforcement, and other applicable stakeholders.
* Reviews and responds to requests for information from Medicare stakeholders as assigned; pursues applicable administrative actions during investigation/case development (e.g., payment suspensions, civil monetary penalties, requests for exclusion, etc.)
* Participates in onsite audits in conjunction with investigation development.
* Provides support of cases at hearing/appeal and ALJ level.
* Maintains chain of custody on all documents and follows all confidentiality and security guidelines.
* Compiles and maintains various documentation and other reporting requirements

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How To Become A Fraud Investigator

Private detectives and investigators typically need several years of work experience in law enforcement or the military. Workers must also have a high school diploma, and the vast majority of states require private detectives and investigators to have a license.

Education

Education requirements vary greatly with the job, but most jobs require a high school diploma. Some, though, may require a 2- or 4-year degree in a field such as criminal justice or police science. 

Corporate investigators typically need a bachelor’s degree. Often, coursework in finance, accounting, and business is preferred. Because many financial investigators have an accounting background, they typically have a bachelor’s degree in accounting or a related field and may be certified public accountants (CPAs). 

Computer forensics investigators often need a bachelor’s degree in computer science or criminal justice. Some colleges and universities now offer certificate programs in computer forensics, and others offer a bachelor’s or a master’s degree.

Training

Most private detectives and investigators learn through on-the-job experience, often lasting several years.

Although new investigators must learn how to gather information, additional training depends on the type of firm that hires them. For instance, at an insurance company, a new investigator will learn on the job how to recognize insurance fraud. Corporate investigators hired by large companies may receive formal training in business practices, management structure, and various finance-related topics. 

Because computer forensics specialists need to both use computers and possess investigative skills, extensive training may be required. Many learn their trade while working for a law enforcement agency for several years. At work, they are taught how to gather evidence and spot computer-related crimes.

Continuing education is important for computer forensics investigators because they work with changing technologies. Investigators must learn the latest methods of fraud detection and new software programs. Many accomplish this task by attending conferences and courses offered by software vendors and professional associations.

Work Experience in a Related Occupation

Private detectives and investigators typically must have previous work experience, usually in law enforcement, the military, or federal intelligence. Those in such jobs, who are frequently able to retire after 20 or 25 years of service, may become private detectives or investigators in a second career.

Other private detectives and investigators previously may have worked for insurance or collections companies, as paralegals, in finance, or in accounting.

Licenses, Certifications, and Registrations

The vast majority of states require private detectives and investigators to have a license. Requirements vary with the state. Professional Investigator Magazine has links to each state’s licensing requirements. Because laws often change, jobseekers should verify the licensing laws related to private investigators with the state and locality in which they want to work.

In most states, detectives and investigators who carry handguns must meet additional requirements.

Although there are no licenses specific to computer forensics investigators, some states require them to be licensed private investigators. Even in states and localities where they are not required to be licensed, having a private investigator license is useful because it allows computer forensics investigators to perform related investigative work. 

Candidates may also obtain certification, although it is not required for employment. Still, becoming certified through professional organizations can demonstrate competence and may help candidates advance in their careers.

For investigators who specialize in negligence or criminal defense investigation, the National Association of Legal Investigators offers the Certified Legal Investigator certification. For investigators who specialize in security, ASIS International offers the Professional Certified Investigator certification.

Important Qualities

Communication skills. Private detectives and investigators must listen carefully and ask appropriate questions when interviewing a person of interest.

Decisionmaking skills. Private detectives and investigators must be able to think on their feet and make quick decisions, based on the limited information that they have at a given time.

Inquisitiveness. Private detectives and investigators must want to ask questions and search for the truth.

Patience. Private detectives and investigators may have to spend long periods conducting surveillance while waiting for an event to occur. Investigations may take a long time, and they may not provide a resolution quickly—or at all.

Resourcefulness. Private detectives and investigators must work persistently with whatever leads they have, no matter how limited, to determine the next step toward their goal. They sometimes need to anticipate what a person of interest will do next.

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Fraud Investigator Career Paths

Fraud Investigator

Fraud Investigator Demographics

Gender

  • Female

    49.3%
  • Male

    48.9%
  • Unknown

    1.8%

Ethnicity

  • White

    79.5%
  • Hispanic or Latino

    11.6%
  • Asian

    6.6%
  • Unknown

    1.7%
  • Black or African American

    0.7%
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Languages Spoken

  • Spanish

    55.4%
  • French

    9.9%
  • Russian

    5.9%
  • Japanese

    5.0%
  • Italian

    4.0%
  • German

    3.0%
  • Hmong

    2.0%
  • Korean

    2.0%
  • Portuguese

    2.0%
  • Romanian

    1.0%
  • Hindi

    1.0%
  • Bosnian

    1.0%
  • Armenian

    1.0%
  • Thai

    1.0%
  • Croatian

    1.0%
  • Albanian

    1.0%
  • Carrier

    1.0%
  • Chinese

    1.0%
  • Belarusian

    1.0%
  • Persian

    1.0%
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Top Skills for A Fraud Investigator

InvestigativeReportsLawEnforcementAgenciesFraudActivityFraudInvestigationsEnsureComplianceVideoSurveillanceLossPreventionFraudCasesSuspiciousActivityFraudClaimsCustomerServiceIdentityTheftAssistanceSARInsuranceFraudMedicalRecordsAuditMedicaidFraudTrendsFraudDetection

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Top Fraud Investigator Skills

  1. Investigative Reports
  2. Law Enforcement Agencies
  3. Fraud Activity
You can check out examples of real life uses of top skills on resumes here:
  • Prepared comprehensive investigative reports for oral or written presentation.
  • Contacted employers, credit agencies, law enforcement agencies and other public and private entities to secure and verify information.
  • Handled incoming calls regarding fraud activity and worked reports monitoring suspicious and fraudulent activity.
  • Conducted field surveillance and field contacts with recipients for the purposes of obtaining information pertinent to public assistance fraud investigations.
  • Assisted in the monitoring of business owner processes & systems to ensure compliance.

Top Fraud Investigator Employers

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