Insurance Fraud Investigator

BriefYour role

Also known as Claims Investigator · Insurance auditors · Insurance fraud auditor · Insurance fraud examiner

and 3 more

Insurance fraud inspector · Insurance policy processing worker · Special Investigations Unit Analyst

L3 salary: Not published yetSalary figures open with the salaries section.
Upcoming dated changes: 5 changes aheadNext: 24 Dec 2026
Where the changes come from
Each change in the Regulatory calendar comes from an official text, linked on its page.
A change affects this role directly when it names a process that is one of the role's main tasks.
Top critical skills: Insurance claims handling and adjusting
Fraud typologies and controls
Insurance regulation (Solvency II, IDD, NAIC, IRDAI)

What the role does

Insurance Fraud Investigator is a role in Insurance. The family covers underwriting, claims, actuarial, broking, sales and insurance operations. The core skill is insurance claims handling and adjusting, and the main work is fraud prevention and insurance underwriting, claims and policy.

This is a brief profile written from the catalogue. A full profile with a day in the life, level descriptions and the effect of AI is being written.

Levels

L1 Starting out 0-2 years
L2 Independent 2-5 years
L3 Senior or specialist 5-9 years
L4 Leads a team or an area 8-14 years
L5 Leads the function 12+ years

Full level descriptions and job titles

The EFO level names are the common scale; job titles differ between employers.

Levels of Insurance Fraud Investigator
Level	What the work looks like	Typical years	Typical job titles
L1 Starting out	Learns the job; executes defined tasks with supervision	0-2	Banks: Analyst, Junior Analyst, Associate (asset servicing), Trainee, GraduateAsset servicers: Junior, Specialist (entry), Officer
L2 Independent	Owns a process end to end; trains L1; first contact for the team's clients	2-5	Banks: Analyst / Senior Analyst, AssociateAsset servicers: Specialist, Senior Specialist, Senior Officer
L3 Senior or specialist	Deep expertise; handles exceptions and change; represents the function in projects	5-9	Banks: Senior Associate, AVP, Assistant ManagerAsset servicers: Senior Specialist, Expert, Team Lead (small team)
L4 Leads a team or an area	Manages people or a large process; owns budgets or controls; escalation point	8-14	Banks: VP, Manager, Senior ManagerAsset servicers: Team Lead, Manager, Head of Section
L5 Leads the function	Accountable for the function in a legal entity or region; sets priorities and standards	12+	Banks: Director, Executive Director, Managing Director, Head of functionAsset servicers: Head of Department, Director

Skills

The percentage is the skill's share of the role; the bars are drawn relative to the anchor skill, which is shown full.

Critical 3

The job cannot be done without these.

Insurance claims handling and adjustingWeight 15.4%Anchor skillExpected level: practitionerRelevant to you
Fraud typologies and controlsWeight 10.3%Expected level: practitionerRelevant to you
Insurance regulation (Solvency II, IDD, NAIC, IRDAI)Weight 10.3%Expected level: practitionerRelevant to you

Important and supporting skills 18

Important 9

Needed in most positions.

Contract drafting and negotiationWeight 5.1%Expected level: practitionerRelevant to you
Investigative reasoning on anomaliesWeight 5.1%Expected level: practitionerRelevant to you
Complaint handling and relationship recoveryWeight 5.1%Expected level: practitionerRelevant to you
Client service mindsetWeight 5.1%Expected level: practitionerRelevant to you
Attention to detailWeight 5.1%Expected level: practitionerRelevant to you
Risk judgment and escalation instinctWeight 5.1%Expected level: practitionerRelevant to you
Ticketing platforms (ServiceNow)Weight 5.1%Expected level: practitionerRelevant to you
Professional written communicationWeight 5.1%Expected level: practitionerRelevant to you
Ethical judgment in grey areasWeight 5.1%Expected level: practitionerRelevant to you

Supporting 6

Help in many positions.

Insurance pricing, reserving and product economicsWeight 2.6%Expected level: working knowledgeRelevant to you
Advanced Microsoft ExcelWeight 2.6%Expected level: working knowledgeRelevant to you
Empathy and active listeningWeight 2.6%Expected level: working knowledgeRelevant to you
Control mindset (what could go wrong)Weight 2.6%Expected level: working knowledgeRelevant to you
Querying data with SQLWeight 2.6%Expected level: working knowledgeRelevant to you
Working to tight deadlinesWeight 2.6%Expected level: working knowledgeRelevant to you

Useful 3

Occasionally useful.

Data cleaning and validationWeight 0.9%Expected level: working knowledgeRelevant to you
Stakeholder managementWeight 0.9%Expected level: working knowledgeRelevant to you
Data protection and privacy law (GDPR, CCPA, DPDP)Weight 0.9%Expected level: working knowledgeRelevant to you

Processes

The work the role takes part in.

What each process covers

Fraud preventionMainPreventing and investigating fraud against the firm and its clients.
Insurance underwriting, claims and policyMainPricing, underwriting, claims and policy administration.

Dated changes for this role

24 Dec 2026EU Digital Identity Wallets: banks must accept themRelevant to you
1 Jan 2027FINMA circular on nature-related financial risks phases inRelevant to you
30 Jan 2027Revised Solvency II rules apply from January 2027Relevant to you
9 Jul 2027Instant payments: sending and verification of payee outside the euro areaRelevant to you
2 Dec 2027AI Act: high-risk rules for credit scoring postponed to December 2027Relevant to you

See all 5 in the Regulatory calendar

Salary snapshot

Salary figures are not published yet

The L3 salary range for this role, with its sources, will appear here when the salaries section opens.

Certifications

IFoA Actuarial exams (CS/CM) IFoA
CFA Program Level I CFA Institute

Concepts to know

No concept linked yet

Rules, products and terms this role works with are being added to the concepts.

Neighbouring roles

Roles that need many of the same skills, by weighted skill overlap, with the skills you would need to add.

Claims Analyst

95% skill overlap

Your role

Insurance Operations Specialist (Policy Administration)

50% skill overlap

To add: Insurance policy administration, Data entry and record keeping accuracy, Organisation and prioritisation

Your role

Fraud Analyst

47% skill overlap

To add: Transaction monitoring and reporting, Anti-money laundering regulation, Know your customer due diligence

Your role

Chargeback & Disputes Analyst

45% skill overlap

To add: Payments and cards products (schemes, chargebacks, PSD2, open banking), Merchant acquiring and payment processing, Transaction monitoring and reporting

Your role

AML Analyst

44% skill overlap

To add: Transaction monitoring and reporting, Anti-money laundering regulation, Know your customer due diligence

Your role

Underwriting Analyst

43% skill overlap

To add: Credit analysis and creditworthiness, Descriptive statistics and distributions, Reading client needs and dynamics

Your role

Do this job? Suggest a correction

Sources

The EFO role catalogue, with skills, levels and processes. How it is built
ESCO classification of the European Commission (external site) for job titles