15 Fraud Investigator Skills to Help you Succeed on the Job

• Understand the Business.
• Understand Information Source.
• Writing Skills.
• Active Listening.
• Gathering Evidence.
• Excellent Communication Skills.
• Interpretative Skills.
• Practical Knowledge of Fraud Investigation.

A Medicare fraud investigator studies cases related to the misuse of health care insurance. Your duties focus on collecting information on instances of suspected fraud. You review health care data and records to look for evidence of fraudulent activity.

To become a Fraud Investigator, you will need:

• strong communication skills.
• IT skills.
• good attention to detail.
• to be confident and trustworthy.
• good organisation skills.
• to be able to work under pressure.
• strong decision-making skills.

You should be able to identify and investigate any suspicious activities that may cause financial loss to the company. Besides, you should be able to put in place anti-fraud measures and recommend fraud prevention software. You will also be assisting Fraud Analysts and your team members during investigations.

Insurance investigators, as a category of private detective, must have a combination of analytic and people skills to succeed. Exceptional interpersonal skills and are naturally inquisitive. A sense of mutual respect and fairness and highly value ethical behaviour. Good decision-making skills and work well within a …

Common examples of Medicare fraud include billing for services that were not provided, billing of unnecessary services, misrepresenting dates of service, or providers of service, and paying kickbacks for patient referrals.

A health field investigator is a professional who goes out into the world and conducts research to gather the information needed for effective decision-making or policy setting by an agency or healthcare organization.

Personal Characteristics of Fraudsters

• They are living beyond their means.
• Overwhelming desire for personal gain.
• High personal debt.
• A close association with customers.
• Feeling that their compensation is insufficient.
• A wheeler-dealer attitude.
• They feel like it is a challenge for them to beat the system.

7 Steps for Conducting a Fraud Investigation

1. Step 1: Receive and react to an allegation.
2. Step 2: Establish an investigative team.
3. Step 3: Conduct a preliminary assessment.
4. Step 4: Preserve and collect evidence.
5. Step 5: Analyze financial, business, and electronic records.
6. Step 6: Conduct interviews.
7. Step 7: Report the findings.

What skills are needed to become an insurance investigator?

• Organization.
• Written communication.
• Investigation.
• Critical thinking.
• Decision-making.
• Negotiation.
• Persuasion.

Claims adjusters inspect property damage to determine how much the company should pay for the loss. Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim and if so, how much.

Top 5 Most Common Healthcare Provider Fraud Activities

• Billing for medically unnecessary services or services not performed. Dig Deeper.
• Falsifying claims or diagnoses.
• Participating in illegal referrals or kickbacks.
• Prescribing unnecessary medications to patients.
• Upcoding for expensive, medically unwarranted services.