actuarial science
The rules of applying mathematical and statistical techniques to determine potential or existing risks in various industries, such as finance or insurance.
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.
Competences and skills
26 ESCO relationsEssential knowledge 6 competences
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
3 competencesclaims procedures
The different procedures that are used to formally request a payment for a suffered loss from an insurance company.
principles of insurance
The understanding of the principles of insurance, including third party liability, stock and facilities.
Cross-sector
3 competencesfraud detection
The techniques used to identify fraudulous activities.
insurance law
The law and legislation concerning the policies of transferring risks or losses from one party, the insured, to another, the insurer, in exchange for a periodic payment. This includes the regulation of insurance claims and the business of insurance.
types of insurance
The various types of risk or loss transfer policies that exist and their characteristics, such as health insurance, car insurance or life insurance.
Essential skills and competences 7 competences
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
4 competencesanalyse claim files
Check the claim from a customer and analyse the value of the lost materials, buildings, turnover or other elements, and judge the responsibilities of the different parties.
assess customer credibility
Communicate with customers to assess whether their true intentions are in line with what they claim in order to eliminate any risks from a potential agreement with the customer.
interview insurance claimants
Interview people who have filed claims with the insurance corporation they are insured with, or through specialised insurance agents or brokers, in order to investigate the claim and the coverage in the insurance policy, as well as detect any fraudulous activities in the claims process.
review insurance process
Analyse all documentation related to a specific insurance case in order to ensure that the application for insurance or the claims process was handled according to guidelines and regulations, that the case will not pose significant risk to the insurer or whether claims assessment was correct, and to assess the further course of action.
Cross-sector
3 competencesassist police investigations
Assist in police investigations by providing them with specialised information as a professional involved in the case, or by providing witness accounts, in order to ensure the police have all relevant information for the case.
conduct financial audits
Evaluate and monitor the financial health, the operations and financial movements expressed in the financial statements of the company. Revise the financial records to ensure stewardship and governability.
detect financial crime
Examine, investigate, and notice possible financial crimes such as money laundering or tax evasion observable in financial reports and accounts of companies.
Optional knowledge 1 competence
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
0 competencesNo competences in this bucket.
Cross-sector
1 competencedebt systems
The processes needed to obtain goods or services before payment and when a sum of money is owed or overdue.
Optional skills and competences 12 competences
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
3 competencesclassify insurance claims
Process incoming claims in order to assess their nature and categorise them according to the different types of insurance and claims handling procedures, in order to ensure proper administrative handling, and to guaranee that the claim may proceed to the correct loss adjuster or other claims professionals.
collect property financial information
Collect information concerning the previous transactions involving the property, such as the prices at which the property had been previously sold and the costs that went into renovations and repairs, in order to obtain a clear image of the property's value.
manage claim files
Follow up on the progress of a claim file, keep all parties informed of the status of the file, ensure the customer receives the damages owed, treat any problems or complaints from customers, close the file and give information to an authorised person or department when there is suspicion of fraud.
Cross-sector
9 competencesanalyse financial risk
Identify and analyse risks that could impact an organisation or individual financially, such as credit and market risks, and propose solutions to cover against those risks.
document evidence
Document all evidence found on a crime scene, during an investigation, or when presented in a hearing, in a manner compliant with regulations, to ensure that no piece of evidence is left out of the case and that records are maintained.
interpret law
Interpret the law during the investigation of a case in order to know the correct procedures in handling the case, the specific status of the case and the parties involved, the possible outcomes, and how to present the best arguments for the most favourable outcome.
manage claims process
Manage the relation with an insurer related to its obligation to receive, investigate and act on a claim filed by an insured.
obtain financial information
Gather information on securities, market conditions, governmental regulations and the financial situation, goals and needs of clients or companies.
perform debt investigation
Use research techniques and tracing strategies to identify overdue payment arrangements and address them
prepare financial auditing reports
Compile information on audit findings of financial statements and financial management in order to prepare reports, point out improvement possibilities, and confirm governability.
present evidence
Present evidence in a criminal or civil case to others, in a convincing and appropriate manner, in order to reach the right or most beneficial solution.
trace financial transactions
Observe, track and analyse financial transactions made in companies or in banks. Determine the validity of the transaction and check for suspicious or high-risk transactions in order to avoid mismanagement.