Multi disciplinary Approach to Fraud Detection and Prevention for Insurance Industry Course

Course Details

Multi-disciplinary Approach to Fraud Detection and Prevention for Insurance Industry Course

Course Description

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

Module 1: Ethical Governance and Foundations of Insurance Fraud Management

• Governance and ethics in the insurance industry
• Ethics in the workplace and conflicts of interest
• Fraud, misconduct, and moral hazards in insurance
• Adverse selection and the anti-fraud mindset
• Conducting ethics investigations and investigator competencies

Module 2: Insurance Fraud Typologies and Prevention Strategies

• Understanding major types of insurance fraud
• Life, health, auto, and property insurance fraud schemes
• The role of brokers in fraud prevention and detection
• Internal audit functions and anti-fraud responsibilities
• Anti-fraud measures, in-house fraud units, and software-based detection systems

Module 3: Fraud Investigation Techniques and Evidence Gathering

• Roles and responsibilities of fraud investigators
• Setting investigation standards and reviewing internal controls
• Identifying and reporting fraudulent claims
• Cognitive interviewing techniques and investigative approaches
• Collecting, analysing, and corroborating evidence during investigations

Module 4: Multi-Disciplinary and Criminal Investigation Approaches to Insurance Fraud

• The multi-disciplinary approach to fraud investigations
• Legal and theoretical issues in fraud investigations
• Principles of criminal investigations in insurance fraud cases
• Interviewing, interrogation, and statement-taking techniques
• Advanced investigative techniques and managing broker fraud risks

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.