Becoming A Certified Insurance Fraud Investigator: Steps To Take

Insurance fraud is a pervasive issue in the United States, costing the average American family between $400 and $700 each year. As a result, insurance investigators are in high demand. These professionals are responsible for researching and verifying insurance claims to detect fraud, gathering information from various sources, and reporting their findings to legal professionals. To become a certified insurance fraud investigator, individuals typically need a combination of education, relevant work experience, and professional certifications. While the specific requirements may vary, here is a general overview of the steps to become a certified insurance fraud investigator.

Get a bachelor's degree in criminal justice or a related field

A bachelor's degree in criminal justice or a related field is a common requirement for those seeking to become certified insurance fraud investigators. This educational background provides a solid foundation in legal knowledge, as well as the necessary skills in research, investigation, and critical thinking.

While a degree in criminal justice is a preferred qualification, individuals with degrees in other fields may also be considered for insurance investigator roles. For instance, an engineering degree can be useful for investigating factory insurance claims, while an accounting degree can be advantageous for examining business fraud. Additionally, degrees in business administration, finance, or risk management can also open up professional opportunities in insurance investigation.

It is worth noting that some employers may accept candidates with only a high school diploma, provided they have relevant work experience or education. However, pursuing a bachelor's degree in criminal justice or a related area can significantly enhance your knowledge and skills, making you a more competitive candidate in the insurance investigation field.

The knowledge gained through a bachelor's degree program will empower you to effectively navigate the complexities of insurance fraud investigations, including conducting research, examining evidence, interviewing victims and witnesses, and working collaboratively with law enforcement officials.

Furthermore, a bachelor's degree is often a prerequisite for obtaining professional certifications in insurance fraud investigation, such as the Certified Insurance Fraud Investigator (CIFI) certification offered by the International Association of Special Investigation Units (IASIU). This certification, designed for individuals with advanced skills in detecting, investigating, and deterring insurance fraud, typically requires a minimum of three years of experience in insurance fraud analytics in addition to a bachelor's degree.

Gain work experience in fraud detection or law enforcement

Gaining work experience in fraud detection or law enforcement is crucial for aspiring insurance fraud investigators. This experience enables you to develop the skills and knowledge necessary to effectively investigate insurance fraud. Here are some ways to gain valuable work experience in this field:

• Pursue internships or part-time work: While completing your degree, seek out internships or part-time roles that can provide hands-on experience in fraud detection or law enforcement. These opportunities allow you to apply your knowledge in a practical setting and develop valuable skills such as research, evidence collection, and interviewing.
• Network with professionals: Attend industry events and join professional organizations, such as the Association of Certified Fraud Examiners (ACFE). Connect with experienced fraud investigators or law enforcement professionals. They can offer mentorship, insights, and guidance on career development.
• Utilize job boards: Websites like the ACFE's job board can be a great resource for finding entry-level positions or internships in fraud investigation and law enforcement. These roles can provide valuable on-the-job training and help you develop the skills needed for a career in insurance fraud investigation.
• Develop specialized skills: Enhance your employability by developing specialized skills sought after in fraud investigation and law enforcement. These skills include analytical and critical thinking abilities, strong communication and interviewing techniques, and a thorough understanding of insurance law and fraud detection methods. You can gain these skills through education, training, and hands-on experience.
• Prior law enforcement experience: Previous experience in law enforcement is highly valuable for a career in insurance fraud investigation. If you have a background in law enforcement, highlight this experience when applying for insurance fraud investigator roles, as it demonstrates your investigative skills and knowledge of legal procedures.
• Gain industry-specific knowledge: Familiarize yourself with the insurance industry, including insurance law, claims processing, and common types of insurance fraud. This knowledge will be invaluable when investigating insurance fraud and can be gained through education, certifications, or working in the insurance field.

Remember that gaining work experience in fraud detection or law enforcement is a crucial step towards becoming a certified insurance fraud investigator. It equips you with the skills, knowledge, and practical understanding needed to excel in this challenging and rewarding career.

Pass an exam to become a Certified Fraud Examiner (CFE)

Passing the Certified Fraud Examiner (CFE) exam is a significant step in becoming a certified insurance fraud investigator. The exam is administered by the Association of Certified Fraud Examiners (ACFE), the world's largest anti-fraud professional group. To be eligible to take the exam, candidates must be associate members of the ACFE and meet certain educational and work experience requirements.

The CFE exam covers various topics, including fraud prevention and deterrence, financial transactions and fraud schemes, and investigations related to interviewing and obtaining information. Candidates are assessed on their knowledge of criminal and civil law and their ability to apply this knowledge in the context of fraud examination.

To prepare for the CFE exam, candidates can take advantage of resources such as the CFE Exam Prep Course offered by the ACFE. This optional course provides study questions, practice exams, and explanations to help candidates familiarise themselves with the exam format and content. It is recommended that candidates aim for a score of 85% or higher on the practice exams to ensure they are adequately prepared.

The CFE exam can be taken online or in person at a Prometric testing site. It is divided into four sections, each lasting approximately two hours. Candidates must achieve a score of 75% or higher on each section to pass the exam. The ACFE allows candidates up to three attempts to pass each section. Once a candidate has successfully passed the exam, they will undergo a final review by the ACFE Certification Committee before receiving their official certification.

In addition to passing the CFE exam, candidates should be aware of the ongoing requirements to maintain their certification. Certified Fraud Examiners are expected to adhere to a Code of Professional Ethics, pay annual membership fees, and complete a minimum number of continuing education hours each year to remain certified. These requirements ensure that CFEs stay up-to-date with the latest advancements and ethical standards in the field of fraud examination.

Earn the Certified Insurance Fraud Investigator (CIFI) certification

The Certified Insurance Fraud Investigator (CIFI) certification is offered by the International Association of Special Investigation Units (IASIU). This certification is designed for individuals seeking advanced skills in detecting, investigating, and deterring insurance fraud. The IASIU sets a high standard for admission and testing, requiring candidates to demonstrate competency through mandatory continuing professional education and adherence to a code of ethics.

Requirements for CIFI Certification

To qualify for the CIFI certification, candidates must meet specific educational and experiential requirements. The IASIU uses a point system, with a minimum of 100 points needed to apply for the examination. Here are the key requirements:

• Educational qualifications: Candidates must have a bachelor's degree from an accredited college, with 20 points awarded for this qualification. Additional points are given for higher degrees, such as a Master's Degree (10 points) or a Ph.D. or J.D. (10 points each).
• SIU investigative experience: A minimum of 30 points is required in this category, with 10 points awarded for each full year of SIU investigative experience. This experience can be gained through employment with insurance companies, self-insured corporations, or state fraud bureaus dedicated to investigating insurance fraud.
• Other investigative experience: This includes law enforcement investigative experience, insurance investigation experience, licensed private investigator experience, and defence counsel investigative experience, with 5 points awarded per year of experience in these areas.
• Public speaking and writing: Candidates can earn points by publishing books, papers, or articles related to insurance fraud investigation, giving lectures at industry events, or holding certifications from professional organisations focused on fraud detection and prevention.

Examination Process

The CIFI Examination Application requires a minimum of 100 points, with 30 points coming from SIU investigative experience. The exam can be taken in-person at chapter events or the Annual Conference, or online with a remote proctor. The exam covers various topics, including insurance fraud terminology, software utilisation, organised fraud case studies, and medical fraud case studies.

Maintaining CIFI Certification

Once certified, individuals must recertify every three years to maintain their CIFI status. This involves upholding the standards set forth in the IASIU's Code of Ethics and obtaining 60 continuing education units (CEUs) over a three-year period, including a mandatory ethics course. CEUs must relate to the investigation of insurance fraud, and proof of attendance or completion must be maintained and submitted to the IASIU.

Develop skills in research, communication, and critical thinking

Developing skills in research, communication, and critical thinking is essential for becoming a certified insurance fraud investigator. Here are some detailed insights into each of these areas:

Research Skills

Fraud investigators need to be adept at conducting independent research and examining evidence. This involves reviewing financial records, analysing transactions, and identifying anomalies or suspicious activity. Investigative techniques such as data mining and auditing are crucial for uncovering fraudulent patterns and discrepancies in financial data. Investigators must also be skilled in using advanced fraud detection technology to analyse large datasets efficiently.

Communication Skills

Excellent communication skills are vital for fraud investigators, as they interact with a diverse range of individuals, including victims, witnesses, suspects, law enforcement officials, attorneys, and prosecutors. Investigators must be able to explain complex technical information clearly and concisely to individuals with varying levels of understanding. Ethical and objective communication is essential, especially when dealing with sensitive information or testifying in courtroom proceedings.

Critical Thinking Skills

Critical thinking enables fraud investigators to analyse evidence, identify deceptive behaviour, and make logical conclusions about the presence of criminal intent. Investigators must be adept at detecting lies, withheld information, and suspicious activities. They need to think critically about the information they review, identifying trends, patterns, and potential indicators of fraud. Critical thinking skills also assist in writing detailed and accurate reports that effectively communicate the findings of an investigation to relevant stakeholders.

Developing these skills in research, communication, and critical thinking will provide a strong foundation for a career in insurance fraud investigation. These abilities will enable you to navigate the complex landscape of fraud detection, evidence gathering, and effective collaboration with various stakeholders.

Frequently asked questions