INTRODUCTION
It provides an understanding of key points about how to prevent fraud from happening and how to detect fraud. It gives definition of nature and types of antifraud. 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. It gives samples about anti fraud technology in claims, underwriting and other areas. It gives idea about other tools to investigate fraud, and how to gather a case for prosecution.
PROGRAMME OBJECTIVES
- Definition of insurance fraud prevention
- Understanding of anti fraud regulation
- Defining the role of ethics in insurance fraud prevention
- Distinguishing the nature and types of insurance fraud
- Desribing internal fraud activities
- Describing external fraud activities
- Identifying anti-fraud measures
- Implementing anti-fraud measures
- Understanding anti fraud technology in claims, underwriting and other areas
- Setting up fraud prevention employees for the organization
- Understanding gathering a case for prosecution
WHO SHOULD ATTEND?
- Insurance Professionals
- Actuaries
- Brokers
- Agents
- Internal Auditors
- Risk Managers
- Internal Control Officers
- Compliance Officer
- IT professionals
PROGRAM OUTLINE
- Defining insurance fraud and fraud prevention
- Describing insurance anti fraud regulation
- Understanding fraud warnings, fraud plans and
- Preparing mandatory reporting of suspected fraud.
- Understanding efficient and cost-effective anti-fraud efforts
- Defining ethics
- Understanding conflicts of interest
- Understanding Racism and other misconduct
- Defining ethics investigations
- Describing skills and approaches of the ethics investigator
- Understanding moral hazard in insurance
- Adverse selection
- Describing life insurance fraud
- Describing health insurance fraud
- Desribing auto insurance fraud
- Describing property insurance fraud
- Desribing internal fraud activities
- Describing external fraud activities
- Identifying anti fraud measures
- Implementing anti fraud measures
- Understanding anti fraud technology in:
- claims
- underwriting
- other areas
- Defining tasks of the fraud investigator
- Understanding reviewing controls
- Understanding multi-disciplinary approach to fraud investigations
- Explaining principles of criminal investigation
