Health Claim Surveyors
Core
Investigate suspicious insurance claims involving fraud, criminal activity, arson, falsified documents, or unnecessary medical procedures.
Role type
Claims investigator / fraud surveyor
Builds
Fraud determinations and evidence reports for insurance companies
Domain
Insurance / Healthcare fraud investigation
Deliverable
client delivery
Required skills
medical record review, physician consultation, surveillance monitoring, background checks, facility inspection, court testimony, data reporting
Preferred skills
none stated
Technologies
universal database
Responsibilities
Consult hospital records and physicians; examine photos, statements, and surveillance media; obtain oral statements from claimants; inspect medical facilities and verify licenses; perform surveillance to verify injury claims; document suspicious activity; report findings to insurance companies; testify in court regarding fraud accusations
Seniority
Individual Contributor