100+ Free CIFI Practice Questions

Candidates must document qualifying experience and education through IASIU's scoring matrix. Typical qualifying experience includes SIU investigator, claims investigator with fraud focus, law enforcement fraud investigator, or prosecuting attorney. Candidates must also be IASIU members (individual or agency) and agree to the IASIU Code of Ethics. The application requires references and detailed experience documentation.

The CIFI exam covers five main areas: (1) Insurance fraud fundamentals and law; (2) Fraud schemes across property/casualty, auto, health, life/disability, and workers compensation; (3) Claim investigation process including EUO and reservation of rights; (4) SIU investigative techniques including surveillance and industry databases; (5) Legal compliance (HIPAA, FCRA, state fraud reporting) and ethics.

An Examination Under Oath is a formal, recorded testimony of an insured, taken under oath pursuant to a cooperation clause in the insurance policy. EUOs are used when investigators suspect material misrepresentation or need detailed factual testimony. Unlike a deposition, an EUO is a contractual right of the insurer, not governed by civil rules of procedure. Refusal to submit to an EUO is typically grounds for claim denial.

ISO ClaimSearch is the insurance industry's comprehensive all-claims database, covering property and casualty claims across participating carriers. NICB (National Insurance Crime Bureau) is a not-for-profit organization maintaining the ISO/NICB database for fraud intelligence. Together they let investigators identify claims history, multiple claims by the same party, suspect providers, and patterns consistent with fraud rings. CIFI candidates must know how and when to query these databases.

HIPAA's Privacy Rule generally restricts disclosure of Protected Health Information (PHI), but contains specific exceptions for health care fraud investigation (45 CFR 164.512). Insurers investigating their own claims can access PHI for treatment, payment, and operations. Law enforcement exceptions also apply. CIFI investigators must know when an authorization is required versus when an exception applies, and must use minimum necessary standards.

The CIFI credential is valid for 3 years. Renewal requires accumulation of Continuing Education Units (CEUs) through approved activities — IASIU conferences, in-house training, published articles, industry seminars, and committee service. Recertification also requires maintenance of IASIU membership and adherence to the IASIU Code of Ethics. Lapsed credentials may be reinstated per IASIU policy.