Fraud Detection and Prevention for the Insurance Industry

Why Attend

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 the 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.

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.

Course Objectives

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

Target Audience

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.

Target Competencies

  • Auditing
  • Preventing insurance fraud
  • Detecting insurance fraud
  • Implementing anti-fraud measures
  • Investigating fraud

Location:

AATICD Campus or Online or Inhouse

Training Dates:

Course starts every Monday of every Week.

Course Fees:

To be sent via Proforma Invoice to your e-mail

Note: Please fill in the online application form on the left or bottom if this page to receive a quotation from AATICD.

How to Apply:

To Apply Simply Fill in the Online Enquiries / Applications form on the Right Sidebar or Bottom of this website http://www.aaticd.co.za

NB:

When filling the online application form; please take note of your desired Training Month, Duration in Weeks and Training Session. This will give us the exact dates you will be attending your classes.

Also note that Tuition Fees must be paid upfront on or before training start date. This is to ensure that all resources are made availabe for you before you start. You will not be allowed into training if fees are not paid and verified.

Also note that Tuition Fees Cancellations must be made 14 business working days before the starting date of training. This will allow us to do a 50% refund of the total amount paid. If cancellations are made thereafter note that no refund will be made to delegates.

Tuition Fees include teas and lunch as well as either a laptop or tablet which a delegate will take home free of charge.

Tuition Fee DOES NOT include Accommodation, Dinners and other Extra Curricular Activities or Incidentals. Delegates are expected to fund this on their own. AATICD will not be held accountable for any incidents to delegates.

In-House Trainings are also available for 10 or more delegates for any duration. Please consult with our Administration for such In-House training bookings.


Course Outline

  • 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 mindset
    • 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
      • The multi-disciplinary approach to fraud investigations
      • General legal issues
    • Criminal Investigations
      • Principles of a criminal investigation
      • Collecting and systemizing of evidence
      • Forming statements
      • Interviewing and interrogation
      • Polygraph and statement analysis
      • Criminology/legal issues
      • Investigative techniques