This course covers how to prevent fraud from happening, how to detect fraud, the tools to investigate fraud, and how to gather a case for prosecution. This course gives professionals working in the insurance industry the ability to protect their organization from internal fraudulent activity such as Agent/Broker premium diversion, re-insurance fraud and rented asset schemes. It also covers external fraud activities such as fake insurance companies, offshore/unlicensed internet companies, staged auto accidents, viatical and senior settlement fraud.
By the end of the course, participants will be able to:
Define the role of ethics in insurance fraud prevention
Distinguish the nature and types of insurance fraud
Set up fraud prevention methods for the organization
Identify and implement anti-fraud measures and manage fraud risks
Investigate and form a legal case to prosecute suspected fraudsters
Content
Governance and ethics in insurance
Defining ethics
Ethics in the workplace
Conflicts of interest
Fraud
Racism
Other misconduct
Conducting ethics investigations
Skills and approaches of the ethics investigator
Moral hazard in insurance
Adverse selection
Fighting fraud types
Core foundation: basic concepts of fraud, anti-fraud mind set
Life insurance fraud
Health insurance fraud
Auto insurance fraud
Property insurance fraud
Reporting insurance fraud
The role of the fraud investigator
Internal audit’s role in preventing fraud
The broker’s perspective
Types of fraud
The broker’s role
Anti-fraud measures
In house anti-fraud units
Software alerts
Databases facilitating sharing of claims information (e.g., CUE, MIAFTR, MID, CIFAS)
Cognitive interviewing techniques
Lie detectors/voice stress analysis
Aerial photography and mapping
Managing broker fraud risks
Broker response to fraud
Fraud Investigations
Tasks of the fraud investigator
Setting the standards
Reviewing controls
Searching for corroborating evidence
Spotting fraudulent claims
Theoretical and legal issues pertaining to fraud investigations
Multi-disciplinary approach to fraud investigations
General legal issues
Criminal Investigations
Principles of criminal investigation
Collecting and systemizing of evidence
Forming statements
Interviewing and interrogation
Polygraph and statement analysis
Criminology/legal issues
Investigative techniques
Course Target
This course is designed for all levels of auditors, investigators and prosecutors working in the insurance fraud arena. Any professional looking to expand their knowledge of insurance fraud detection and prevention would also benefit from this course.
