Insurance Fraud Investigations
Licensed SIU & Fraud Investigators. Case-Ready Results.
Encyphir conducts insurance fraud investigations for carriers, TPAs, self-insured employers, and defense counsel. We cover workers' compensation, auto, property, health, life, and commercial lines. Our licensed investigators and CFE-credentialed examiners build the evidence record your SIU and counsel need to deny, recover, and refer.
Full-Line Fraud Investigation
Fraud Investigation Services for Insurance Carriers, TPAs, and Defense Counsel
Every fraud scheme is different. A soft-fraud exaggeration, a staged-accident ring, and a provider billing scheme each need different methods. We handle all three. Reporting is prepared to carrier SIU standards and formatted to plug into your claim file.
Our Methodology
How a Case Gets Built
Every investigation follows the same defensible methodology, scaled to the complexity of the claim. Single-claim referral or multi-carrier ring, the work is planned, documented, and reported the same way. Your SIU, defense counsel, and prosecutors can all rely on it.
Investigation Pillars
- Red Flag Review & Case AssessmentWe analyze the file for fraud indicators, prior loss history, and pattern matches. Then we recommend a scoped, proportionate investigative plan.
- Evidence Gathering & DocumentationScene investigation, recorded statements, witness interviews, medical canvass, social media and OSINT, ISO ClaimSearch, CLUE, and NICB ForeWarn. All preserved to evidentiary standards.
- Analytics & Link AnalysisData analysis, pattern recognition, and link analysis across claims, providers, attorneys, and addresses to surface organized fraud rings and recurring schemes.
- Reporting, SIU Support & TestimonyClear, defensible SIU reports ready for declination and DOI referral. Expert witness deposition and court testimony available when the case goes to prosecution.
Who We Support
Carriers, TPAs, and Counsel
Insurance Carriers & SIUs
Overflow and specialty support for in-house SIUs. We handle referrals your team doesn't have the bandwidth or regional presence to cover. Reports are formatted to plug into your existing workflow.
TPAs, MGAs & Self-Insured Employers
Third-party administrators, managing general agencies, captive insurers, and self-insured employers rely on us for independent, carrier-grade fraud investigation and documentation.
Defense & Coverage Counsel
Defense and coverage counsel retain us for EUO support, recorded statements, background research, and expert reports for civil and criminal fraud matters.
Why Encyphir?
- Licensed investigators nationwide
- CFE-credentialed financial fraud expertise on staff
- ISO ClaimSearch, CLUE, and NICB ForeWarn access
- HIPAA / FCRA / GLBA-compliant investigations
From Our Blog
Insurance Fraud Resources
Request a Free Consultation
Fill out the form and we'll reach out via your preferred contact method within 24 hours.
- Licensed & insured investigators
- All inquiries are strictly confidential
- No obligation - just answers
- Available for emergency consultations
For emergency or expedited services,
please call us directly:
(888) 965-5150
Other Services
Surveillance Operations
Covert and overt surveillance using professional equipment and proven tradecraft. Court-admissible video and photo documentation.
Background Investigations
Comprehensive screening with live interviews, credential verification, and proprietary source access beyond standard database searches.
Digital Forensics & OSINT
Computer, mobile, and online evidence investigation following strict chain-of-custody protocols for court admissibility.
Security Consulting
Corporate and residential security assessments, threat mitigation planning, and personnel risk management.
Training Services
Active shooter response, de-escalation, SB 553 workplace violence prevention, and First Aid certification.
Due Diligence
Pre-acquisition and business partner investigations combining database research, live interviews, and on-the-ground verification.
For Law Firms
Litigation support, witness location, evidence gathering, and expert testimony for attorneys and law firms.
Have a Suspicious Claim?
Send the referral. We scope a proportionate investigation, document evidence to SIU standards, and deliver a clear report that supports your denial, recovery, or referral decision. Consultations are free and confidential.