An Insurance Field Verification Investigator (often called an Insurance Claims Investigator or Risk Management Executive) plays a critical role in preventing financial leakages for insurance companies. Their main job on the ground is to detect fraud, verify facts, and check if claims are genuine before the company pays out money.
Here is a comprehensive Job Description (JD) formatted for corporate use:
Job Title: Insurance Field Verification Investigator
Department: Risk Management / Fraud Control Unit (FCU) / Investigation Cell
Reports To: Area Investigation Manager / Head of Claims
Employment Type: Full-time / Emparnelled Agency Partner
Job Purpose
To conduct discrete, high-quality, on-ground field investigations and audits for disputed or suspicious insurance claims (Health, Motor OD, and Third-Party MACT). The investigator is responsible for gathering evidence, analyzing accident dynamics, verifying medical/legal records, and exposing fraudulent manipulation or inflation of claims to protect the company from financial risk.
Core Responsibilities & Key Result Areas (KRAs)1. On-Ground Field Audits & Site Visits
- Physically visit accident spots, hospital premises, claimant residences, and workplaces to verify the physical truth of reported incidents.
- Conduct discrete neighborhood inquiries and interview independent witnesses to map real-time event timelines.
- Capture geo-tagged, time-stamped photographs and video evidence of scene layouts, structural assets, and vehicle damages.
2. Medical Record & MLC Analysis (For Health & Accident Claims)
- Visit treating hospitals and medical centers to audit original admission logbooks, casualty charts, and Medico-Legal Case (MLC) registries.
- Cross-examine in-house pharmacies, outpatient departments (OPD), and diagnostic laboratories to verify bill splits and prevent over-billing.
- Identify fraud patterns like "Self-Fall conversion" (converting a personal slip-and-fall into a vehicular third-party accident claim) and pre-existing illness concealment.
3. Legal & Regulatory Compliance Audits (For Motor & TP Claims)
- Coordinate with jurisdictional police stations to cross-check physical records of First Information Reports (FIR), General Diaries (GD), and Charge Sheets.
- Verify driving license (DL) records through government portals (like SARATHI) to confirm category endorsements and validity at the time of the accident.
- Inspect vehicle structural parameters to verify that physical damage correlates with the reported accident mechanics.
Pay: ₹15,000.00 - ₹25,000.00 per month
Work Location: In person
