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What Does a Fraud Agent Do?

G. Wiesen
G. Wiesen

The responsibilities of a fraud agent typically involve the investigation of cases or instances in which a business or organization suspects a fraudulent action may have taken place. This type of agent often works for a financial institution, such as a bank, insurance company, or money lender, and reviews or investigates different reports. This often begins with a general overview of paperwork filed and claims being made, but may require research and investigation in the field to observe people or to conduct interviews. A fraud agent then typically concludes a case by making a final report that is filed with his or her employer and indicates suggested actions.

One of the first actions a fraud agent, sometimes called an investigator or officer, takes is to obtain and review cases that may be fraudulent in nature. For example, if an insurance company receives a claim from a client, then they may send the paperwork to the agent. The agent then looks at this data to determine its initial legitimacy, which can involve double-checking basic information provided on the claim and ensuring it is filled out properly. In this early stage, a fraud agent might approve the paperwork and pass it along, or decide that further investigation is required.

A fraud investigator may investigate claims of disability.
A fraud investigator may investigate claims of disability.

As another example, a fraud agent working for an insurance company might decide that a claim seems to be suspect and interview the person who filed it. Further research may include speaking to medical or legal professionals involved with the person making the claim, and ensuring that information provided by the claimant is legitimate and accurate. A fraud agent at a bank or money lending organization might check references provided on paperwork and perform a background check on someone. The exact nature of the research performed during an investigation can vary depending on the nature of a case, but it is typically done to determine the legitimacy of a claim.

Once a fraud agent has established whether paperwork is accurate, then he or she can provide further instruction to his or her employer. If the investigation does not turn up anything suspicious, then the officer might recommend that a claim or loan be approved. When research or background checks indicate that there may be fraudulent activity occurring, then the agent is likely to instruct his or her employer to decline the claim. There are often legal ramifications that can occur when this type of fraud or abuse is found, so a fraud agent may need to contact law enforcement professionals and provide them with the information that he or she has gathered.

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    • A fraud investigator may investigate claims of disability.
      By: Luis Louro
      A fraud investigator may investigate claims of disability.