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  and senior settlement fraud.

Course Objective

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

Course Outline

• Governance and ethics in insurance
• Defining ethics
• Ethics in the workplace
• Conflicts of interest
• Fraud
• 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
• Cognitive interviewing techniques
• Lie detectors/voice stress analysis
• 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
• Criminal Investigations
• Principles of criminal investigation
• Collecting and systemizing of evidence
• Forming statements
• Interviewing and interrogation
• Investigative techniques

Who Should Attend

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.

Methodology

This course uses a mixture of presentations, discussions, case studies, videos, role-plays and interactive exercises to transform participants’ knowledge into hands-on practice.