Career Path Chart

You may be entering the field of claims investigation by leveraging your insurance expertise (likely in claims) or through your previous work experience in policing, private investigations, criminology, engineering, accounting, etc.

In either case, this stage in your career will focus on being a ‘sponge’ to either hone your investigation/fraud detection skills or build your understanding of the craft of insurance.

Curiosity

Commitment to Continuous Learning

Team Player

Investigative

Detail Oriented

Both Formal and Informal mentorship can prove valuable – visit the Mentoring Advantage website for tools and tips on maximizing the mentoring relationship as you move into the field of claims investigation. Your company may also have resources and opportunities available.

These relationships may be most beneficial in the areas of solidifying or enhancing your insurance knowledge and drawing on the mentor’s insurance experience and subject matter expertise.

Where you choose to focus you learning at this stage in your career will be highly dependent on your entry point into the area of claims investigation.

If you are coming from another industry, you may have completed or are working towards your first course C11 – Principles and Practices of the Chartered Insurance Professional (CIP) designation or the Insurance or General Insurance Essentials (GIE) Certificate (equivalent to C11) through the Insurance Institute of Canada. Working towards completing your CIP or other specialized seminars will likely prove extremely beneficial in equipping you with the insurance knowledge to excel in your career.

Should you have experience working in the insurance industry already, you likely are close to or have already completed your CIP designation. If you haven’t already, you might find it useful to take C39 – Fraud Awareness and Prevention or seminars focused on fraud and investigations to help equip you with knowledge of the investigations process.

You are focused on learning the fundamentals of insurance and the ins and outs of the investigations process.

The claims you are investigating are likely not overly complex but often represent the core of the personal and commercial insurance risks held by the insurance organization you work for.

You will likely work alongside a more experienced team member or have your investigation supervised by your team leader.

• Your focus will be on developing skills in the following areas:

•  Taking detailed information and statements from clients, witnesses, tertiary professionals (mechanics, home inspectors, fire fighters, police, medical professionals, etc.) concerning the nature of their claim; and, determining if it is in fact valid

•  Using tools and resources available to help you examine and evaluate the claim

•  Liasing with other claims professionals, Brokers, Underwriters, etc. to understand the claims management process to date and parameters established within the insurance policy

•  Developing a solid understanding of the products and lines of business available within your organization

•  Ensuring completion of required forms and documentation in accordance with regulatory and company standards

•  Building and maintaining rapport with clients, colleagues, and stakeholders

• Demonstrating capacity to manage multiple priorities, work to timelines, and to be proactive in addressing emerging issues

•  Fostering solid business communication (verbal and written) and interpersonal skills

•  Supporting gathering of documents, reports, and information to be used in claims mediation or court cases

•  Developing understanding of the legal and regulatory framework governing the insurance sector

If you are already an established insurance professional, you may find it useful to take a ‘step back’ in your level of industry and community engagement to allow ample space to learn and grow in your new role.

Stay connected or Subscribe to on-line newsletters and industry publications (ie. Thompsons, Claims Canada), visit industry websites, and monitor social media channels (ie. Insurance Institute’s LinkedIN Group, Twitter) to broaden your global industry awareness
Consider joining professional associations (ie.your Provincial Adjusters Association, Canadian Independent Adjusters Association ), attending Claims Conferences through your Provincial Adjusters Association or becoming involved at your local Institute/Chapter.

Demonstrating leadership as you begin your career as a claims investigator can come in many forms. Likely though, it begins with listening and curiosity. Some of the industry’s most respected leaders are known for hearing what others are saying, synthesizing information, asking the right questions, and recommending a course of action based on what they have heard.

At this stage, you will be in a prime position to ask questions, make connections, and establish your capacity to actively listen to colleagues, managers, clients/brokers, and the industry’s emerging trends and issues. In this process, you will be establishing other solid foundations for leadership competencies including respect, reliability, and engagement in the business.

Continue to focus on growing your knowledge and experience in order to increase your capacity to manage your investigations with more independence.

This is also a time where you may become more aware of specialties and options available to you –liability, property or casualty claims, forensics, fraud are all examples of areas of specialization within claims investigation.

It is important to try to understand the options available and learn as much as you can about them – whether through exposure on the job, learning in the classroom, mentorship, or simply doing some research on line.

From here, you can decide which ones fit with who you are, what you are good at, and offers possibilities that are in line with what you would like in the next step in your career.

Preparing for multiple possibilities at this point in your career can help keep your options open.

Analytical

Influencer without Authority

Conflict Manager

Relationship Builder

Ethical Decision Making

Formal and informal mentorship can prove valuable – visit the Mentoring Advantage website for tools and tips on maximizing the mentoring relationship. Your company may also have resources and opportunities available.

These relationships may be most beneficial in the areas of understanding how to adapt general knowledge to fit the needs of more specialized claims, ethical decision making, understanding different facets/roles of the insurance business, drivers of policy making (both internal and external) and leveraging the mentor’s insurance experience and/or investigations expertise for a particular problem or need on the job.

As you build and leverage your knowledge through the completion of your Chartered Insurance Professional (CIP) designation, you will find that you are prepared to participate in increasingly complex investigations and operate with a broader scope of settlement authority.

You may also wish to being taking courses through the Association of Certified Fraud Examiners (CFE) towards a specialized designation.

This in combination with continuing to take specialized seminars (ie. Fraud, Flood/Fire Claims, Legal Processes, etc.) and e-learning/webinars will help you in continuing to grow your acumen that can be applied in the fraud and investigations area of the business.

If you are working for an independent adjuster, on-going learning will be key to completing the Continuing Education Credits required to maintain your license.

The focus at this stage in your claims career is building on the experiences you have had to date.

As your experience builds, the nature of the investigations you are working with will become increasingly complex and you will be able to operate with a greater scope of authority to manage and settle claims on behalf of your organization.

Often, your focus will be on growing your confidence and experience in the following areas:

• Building more specialized product knowledge and expertise

• Growing your comfort in managing investigations process with minimal supervision and working with the claims team in settling claims within the parameters outlined in the insurance policy as required

• Applying and adapting general insurance principles to ‘unique’ situations

• Continuing to develop strong working relationships internally with industry professionals (loss control, risk management specialists, underwriters etc.) and externally with the legal, healthcare, restoration services, and construction services that support the claims and investigations process

• Supporting forensic, incident reconstruction, fraud detection, and investigative efforts (either internally or using external consultants) as required

• Focus on honing your capacity to work within the ethical and regulatory frameworks in the business of insurance; includes supporting the claims audit process

• Demonstrating capacity to take initiative, multitask, and deliver on promises

• Leveraging strong business communication (verbal, written, and presentation) and interpersonal skills to support success in day-to-day work and on projects

Attend industry conventions and special events

Connect and network with adjusters, vendors/tertiary providers, and insurers (eg. Claims Seminars, Fraud Focused Conferences/Events, Golf Tournaments)

Volunteer at an organization that resonates with you or at an industry function (ie Institute Convocation, Awards Luncheon, Trends Breakfast, etc.)

At this point in your career, you are starting to better understand the nature of the claims investigations process and/or the business of insurance. Your knowledge, operational capacity, and experience are all in growth mode. From a leadership perspective, this is an opportunity to continue to hone your business acumen and focus on your skills in building strong working relationships both within your organization and externally (ie Underwriters/Wordings Consultants, regulators, tertiary vendors – restoration companies, lawyers, mediators, healthcare professionals, etc.). These skills combined with a strong sense of ethics and teamwork will go a long way in demonstrating your capacity for leadership.

This time in your career may involve a period or periods of questioning what is next – people leadership, increased specialization in the field of investigations, engaging in another area of the insurance business within your organization (ie. Claims, Underwriting, Account Management/Business Development, etc.)

It is important to consider your skills, values, education, and experiences. From here you can take stock about what you are proficient in, what you would like to learn or grow your capacity in next, and make decisions about what your next steps might look like.

You may find it helpful to talk to your manager or HR department about these options in more detail and the tools that are available to support your continued development.

Critical Thinker, Problem Solver, Negotiator, Trends Seeker, Technical Specialist

Formal and informal mentorship can prove valuable – visit the Mentoring Advantage website for tools and tips on maximizing the mentoring relationship. Your company may also have resources and opportunities available.

These relationships may prove to be most valuable in the areas of seeking advice around a tough business question or decision, next steps in your career path, and to validate a course of action in managing a particular professional relationship or business need.

If you are working for an independent adjusting firm, you will want to be mindful of the requirements for Continuing Education to maintain your licensure. You may also want to pursue your Level 2 license (depending on your career ambitions).

As such, you may find that additional learning through the Advanced Chartered Insurance Professional (CIP Adv) Certificate is helpful in supporting your work in the claims space.

There are suggested pathways for claims professionals which include completion of additional courses in the Claims Applied Professionals Stream ( C111 - Advanced Loss Adjusting), looking at increasing your specialization in areas like C32 - Bodily Injury Claims), and a capstone focused on advanced issues impacting the business of insurance within the claims area.
More seasoned claims investigators may also find benefit in completing the requirements for the Certified Fraud Examiners (CFE) designation (offered through the Association of Certified Fraud Examiners).

You may also find the advanced level seminars offered through the Insurance Institute/CIP Society, the Management Development Series, legal workshops and e-learning offerings helpful in continuing to enhance your insurance knowledge, meet continuing education requirements and stay current with emerging trends across the industry

You are managing investigations with high degrees of nuance and complexity. At this stage in your career, you are also operating with a higher degree of independence, are representing the company you work for in mediation/in court and have a growing scope of authority.

Often, the focus in your career will evolve to enhancing your knowledge and expertise as it pertains to investigations, leadership, or special projects.

• More often than not, at this point in your career you may be enhancing your skills in the following areas:

• Applying specialized insurance knowledge and expertise to investigations and claims examination

• Growing your capacity to manage claims investigations, mediations, contracts, etc. independently

• Supporting underwriting and actuarial teams in new product development and/or revision to wordings based on outcomes from the claims investigations process (ie. Fraud prevention)

• If working independently, you will leverage strong working relationships internally with industry professionals (loss control, claims, legal, etc.) and externally to support account management and business development; this includes assisting with claims audit

• Advancing your understanding of the legal and regulatory considerations and drivers within the insurance sector

• Managing forensic, incident reconstruction, fraud detection, and investigative efforts (either internally or using external consultants) as required

• Demonstrating capacity to generate solutions, recommendations, and approaches to emerging issues with minimal input/supervision; may involve providing support to other investigators within the department

Increase your engagement with your local Institute/Chapter. You may be interested in joining a committee or working group.

There are also several boards, Associations and working groups within the Claims area of the business that you might consider becoming involved with depending on your interests and career goals, i.e. Association of Certified Fraud Examiners, Canadian Independent Adjusters Association, Institute for Catastrophic Loss Reduction, etc.
Continue to think about expanding your insurance network – eg. Connecting with other professionals working in your area of specialty – building your tertiary/vendor network, and attending events focused on your areas of professional interest.

Consider becoming an industry Ambassador through the Insurance Institute’s Career Connections Program

At this stage, you are likely to be comfortable in your role and demonstrate a high degree of business acumen as your scope of authority and influence over the claims process continues to increase.

In looking at leadership, you may be thinking about your future roles and whether you would like to be a technical consultant or manager of people. Either require the capacity to work more autonomously, sound problem solving and decision making skills, and an ability to think critically about a situation and its potential impact on your area/organization.

This stage in your career may also provide opportunities for ‘stretch’ assignments, serving as part of project teams/internal committees, or engaging in process improvements within your functional area.

At this stage in your career it is often fair to state that you have deep knowledge and expertise of the investigations and claims area of the business.

There may be mechanisms for you to share your expertise with those with less industry knowledge and experience within your organization either as a senior investigator, team lead, or operational leader.

There might also be opportunity for you to move into Loss Control, Claims, consulting on fraud prevention, or even risk management for a particular product line or specialty.

You will want to evaluate which ‘track’ feels more in keeping with who you are, what you want to do, and what you can offer your organization.

You may find it helpful to talk to your manager or HR department about these options in more detail and the tools that are available to support your continued development.

Consultant, Technical Expert, Operational Leader, Conflict Manager

Given the level of knowledge and experience you likely have amassed at this point in your career, you may be thinking about becoming a mentor yourself. There are lots of great tools on the Mentoring Advantage website that can assist you in your transition from mentee to mentor.

Keep in mind, even senior leaders talk about the importance and value they place on being mentored throughout their career.

Your time with a mentor may be most beneficial if the discussion has a focus on best practices in decision making, strategic thinking, and/or growing your capacity as a leader.

Claims Investigators at this stage in their career are functioning virtually independently and require high degrees of subject matter expertise to manage and advise other professionals with less experience on the claims/investigations process.

If you are pursuing a career with an independent adjuster, you will already have completed or are working towards your highest tier of licensure.

Knowledge required for this stage in your career can be further developed by pursuing the Fellow Chartered Insurance Professional (FCIP) designation and supported through advanced level seminars, CIP Society offerings, Management Development Series, and/or workshops/special events targeted to your area of focus within the industry.

Often at this stage in your claims career you are managing investigations independently and may be called upon to supervise the work of claims adjusters , investigators, and examiners with less industry experience.

The decisions you are making at this stage in your claims career can often impact the overall health of the organizations you represent, could impact risk exposures if not managed appropriately, and influence the procedures, policy, and approach to business at a macro level.

Typically at this stage in your career your skills and experiences will be focused on:

• Transitioning to and serving as a consultant to less experienced professionals

• Leveraging relationships with internal/external customers, and a vast network of tertiary support (ie. healthcare, legal, assessment, restoration services, etc.) to the strategic benefit of the organization

• Contributing to project teams leading new product development or revising product offerings based on outcomes and recommendations from the claims area of the business

• Supporting the development of policies and procedures related to reserving practices, claims auditing, and complex legal processes (ie. class action, binding arbitration, etc.)

• Developing capacity to transfer knowledge, provide counsel, and/or lead teams effectively

• Ensuring internal and external risks are mitigated or controlled appropriately through both insurance coverages and continuity plannin

• Supporting projects implementing new/revised claims management systems

• Influencing and shaping the regulatory framework

You may be interested in volunteering as a member of a local council, becoming an Institute Instructor, or working on a national task force.

Value may also be found in increasing your involvement with industry associations or organizations related to claims at the provincial or national level.

There may also be opportunities to participate in research being conducted within the industry, roundtable/panel discussions, or to present on a topic at an industry conference or event.

Continue to engage your insurance network through participation in industry events, conferences, and functions

Leadership Competencies Demonstrating leadership as you begin your career as a claims investigator can come in many forms. Likely though, it begins with listening and curiosity. Some of the industry’s most respected leaders are known for hearing what others are saying, synthesizing information, asking the right questions, and recommending a course of action based on what they have heard. At this stage, you will be in a prime position to ask questions, make connections, and establish your capacity to actively listen to colleagues, managers, clients/brokers, and the industry’s emerging trends and issues. In this process, you will be establishing other solid foundations for leadership competencies including respect, reliability, and engagement in the business. At this point in your career, you are starting to better understand the nature of the claims investigations process and/or the business of insurance. Your knowledge, operational capacity, and experience are all in growth mode. From a leadership perspective, this is an opportunity to continue to hone your business acumen and focus on your skills in building strong working relationships both within your organization and externally (ie Underwriters/Wordings Consultants, regulators, tertiary vendors – restoration companies, lawyers, mediators, healthcare professionals, etc.). These skills combined with a strong sense of ethics and teamwork will go a long way in demonstrating your capacity for leadership. At this stage, you are likely to be comfortable in your role and demonstrate a high degree of business acumen as your scope of authority and influence over the claims process continues to increase.

In looking at leadership, you may be thinking about your future roles and whether you would like to be a technical consultant or manager of people. Either require the capacity to work more autonomously, sound problem solving and decision making skills, and an ability to think critically about a situation and its potential impact on your area/organization.

This stage in your career may also provide opportunities for ‘stretch’ assignments, serving as part of project teams/internal committees, or engaging in process improvements within your functional area. This stage of your career allows for you to offer your deep knowledge of the claims and investigation function to the benefit of others. This can come in the form of being a technical expert of moving into a capacity where you are managing people.

Both facets will require you to ensure you have capacity or experience in building cross functional relationships, managing conflict effectively, and have a high degree of comfort in taking complex principles and communicating them in an accessible way (both verbally and written) to colleagues, clients, senior management, and external stakeholders.

If you are on a people management track, you may be looking to expand your experience in building effective teams, fostering a climate of engagement, and building your management skills.

This stage may also provide an opportunity for ‘stretch’ assignments with a leadership focus, leading project teams/internal committees, or managing day-to-day functions within your department.