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Banking,
Finance & Insurance
Insurance claims investigators evaluate insurance claims. They decide if the claim is valid, and how much the insurance company will pay.
An
insurance claims investigator’s primary responsibility is to verify if
the insurance claim that a client submits is valid and if so, how much
the insurance company will pay to them. First of all, the insurance
claims investigator needs to review the claim and any relevant documents
to understand what degree of insurance coverage the person making the
claim has. Then, depending on the situation, insurance claims
investigators have several options to consider. They inspect the damage
to property and make an assessment on the severity of it, calculating an
estimate of the damages. They may interview or write to claimants, any
witnesses, emergency services and medical professionals to determine
events and whether there’ll be a claim settlement, further review or if
the claim is denied. Or possibly examine police reports, damage to
property, healthcare treatment and bills to decide up the degree of
liability. Insurance claims investigators need to check every angle and
perspective regarding the insurance claims to ensure that the claim
request is not fraudulent. Once all details are verified and the claim
is deemed valid, the claims investigator negotiates the financial
settlement. If a settlement sum cannot be reached, the claims
investigator recommends what legal options there are. ANZSCO ID:
599611
Knowledge, skills and attributes An insurance claims investigator has a difficult role. Keen attention to detail is very important, whilst examining all the data gathered. You also need good interview and investigative skills coupled with effective communication to get the facts accurately from people. Once all the information is gathered, investigators must assess and decide whether the claim is valid or not. You need sound judgement and good decision-making skills for this part. Finally, once a claim is deemed valid, then the settlement must be calculated, therefore an aptitude for numbers and calculations is important for this role. To become an insurance claims investigator, you would need:
Meet a Claims
Investigator in the Insurance Industry
Duties and Tasks As an insurance claims investigator, you would:
Working conditions In a full-time job you would work standard hours, Monday to Friday. You would often work outside the office, inspecting property that was the subject of insurance claims, such as damaged buildings and vehicles. You would need to drive to the claimant's location or the location of an incident, so would need a current drivers' licence.
Education and training/entrance requirements
A senior secondary school certificate or
equivalent is typically required to work as an entry-level insurance
investigator. In addition, you would need insurance-related work
experience.
Employment Opportunities
As the number of vehicles increases, the number of insurance claims
is also likely to increase. Demand for insurance claims
investigators in property and casualty insurance is influenced by
the number of natural disasters, such as floods and fires. Insurance
officers in these areas may see strong employment growth as the
number of natural disasters increases.
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