Insurance claims investigator

Insurance claims investigators are employed by insurance companies to look into and validate claims made by policy holders. They check that each claim is covered by the terms and conditions of the policy and investigate the cause of loss or damage.

Also known as

Negotiator – insurance claims

Work activities

Insurance cover is available to help customers who have suffered losses caused by events such as theft, accident or illness. The customer pays a regular amount of money (called a premium) and receives a written policy. This sets out the conditions under which the insurance company will provide a settlement by way of repairs, replacement or reinstatement of items. Insurance claims investigators, sometimes known as claims negotiators, are responsible for investigating claims submitted by policy holders. Claims are submitted as a result of events such as personal accident, loss of goods in transit, theft, loss of profits, fire, flood and storm damage. Large-scale disasters such as floods generate a huge number of claims, all requiring urgent attention. When a customer contacts their insurance company to register a claim, they are likely to speak to a claims handler. In some cases, the claims handler will deal with that case all the way through to a settlement. In others, the claims handler will ask an investigator to check the case. Investigators collect evidence in order to check that the claim is genuine, and to assess the level of the settlement. Some investigators might have to interview claimants who are upset, shocked or distressed, especially if death or injuries are involved.

The investigator might need to visit damaged buildings or vehicles in order to gather the evidence needed to determine a settlement. They might collect evidence by talking to solicitors, the police, employers and eye-witnesses. In straightforward claims, an agreement between an insurance company and a claimant can usually be reached quickly. However, even after they have decided whether the insurance company should pay out, it can take a long time to decide what the settlement sum should be. Throughout each case, investigators must be aware that the claim could be false or exaggerated. Some claims need to involve an independent loss adjuster who acts as an impartial link between insurer and claimant, and helps to organise assistance such as building or repair work. Some insurance firms, and many investigators and loss adjusters, specialise in a particular type of insurance such as personal injury, aviation, motor or marine.

Investigators might need to visit a place of work to speak to employers and witnesses, examine accident records, photograph and measure sites and equipment, and collect exhibits for use in evidence. They might give health and safety advice to an employer to try to stop further incidents. Many investigators are based at home. They use a laptop, digital camera and digital voice recorder to keep records and prepare reports; these are sent electronically to their head office.

Personal qualities and skills

As an insurance claims investigator, you’ll need:

To be thorough, methodical, confident and decisive.
Communication skills.
Negotiating and interviewing skills.
To be able to show tact, sympathy and patience when interviewing claimants who are upset, shocked or distressed.
To prioritise and manage a busy case load.
Report-writing skills.

You are very likely to need a full driving licence.

Pay and opportunities

The pay rates given are approximate. Insurance claims investigators start on around £17,000 per year, rising to £50,000 with experience. Other benefits could include profit-related bonuses, a company car, low-rate mortgages, medical insurance, and life and some pension cover.

Investigators usually work 37-39 hours, Monday to Friday. Occasional evening or weekend work might be required.

Employers are insurance companies. Opportunities for insurance claims investigators occur in towns and cities throughout the UK. A high percentage of financial services industry employees are based in London.

Where are vacancies advertised?

Vacancies are advertised in local/national newspapers, on employers’ websites, through the Chartered Insurance Institute careers website, on the Government’s Find a Job service, and on job boards.

Entry routes and training

Some trainee claims investigators might spend several years doing office-based claims handling work before moving into this area. Most employers also recruit graduate trainees from a wide range of academic subjects. Some degree and HND business studies and economics courses include insurance options. There are several degrees and postgraduate courses in risk management available, for example, the MSc in insurance and risk management.

Alternatively, you could enter this profession through a level 4 (higher) apprenticeship in the role of insurance professional. This way, you will carry out the majority of your training in the workplace, while completing one or more relevant qualifications at the same time.

Insurance claims investigators might study for the professional exams of the Chartered Insurance Institute (CII) or the Chartered Institute of Loss Adjusters (CILA). Some degrees could give exemptions from certain of the CII exams. Contact the CII for further details.

Insurance claims investigators can progress to management posts. Some might move into loss adjusting.

Rehabilitation of Offenders Act: Working as an insurance claims investigator could be an exception to the Rehabilitation of Offenders Act 1974. This means that you must supply information to an employer about any spent or unspent convictions, cautions, reprimands or warnings, if they ask you to. This is different from other careers, where you only have to reveal information on unspent convictions if you are asked to.

Qualifications

For direct entry to the Chartered Insurance Institute (CII) Advanced Diploma exams, the recommended prior learning requirement is either three A-levels or equivalent, or the diploma in insurance. Entry to insurance claims careers is also common for those with higher education (HE) qualifications such as an HND, foundation degree or degree.

For entry to a degree course in any subject, the usual minimum requirement is:

Two to three A-levels.
GCSEs at grades 9-4 in two to three other subjects.

Alternatives to A levels include:

Edexcel (BTEC) level 3 National qualifications
International Baccalaureate (IB) diploma.

If you wish to enter this career through a higher apprenticeship, you will need to two relevant A-levels plus GCSEs in English and maths.

Adult opportunities

Age limits: It is illegal for any organisation to set age limits for entry to employment, education or training, unless they can show there is a real need to have these limits.

Some entrants have a background in financial or business-related work. A clean, current driving licence is usually necessary. Some employers prefer to recruit people with a higher education (HE) qualification.

If you don’t have the qualifications needed to enter your chosen degree or HND course, a college or university Access course (for example, Access to Business) could be the way in. These courses are designed for people who have not followed the usual routes into higher education. No formal qualifications are usually needed, but you should check this with individual colleges. The Chartered Insurance Institute (CII) might relax the usual academic entrance requirements for adults who wish to take their exams.

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