Program description & objectives

Insurance fraud is a hydra-headed problem that has been growing in leaps and bound over many decades. The frightening revelation, however, is that most developing economies and the responsible regulatory agencies/parastatals are not yet focused on the immense level of fraud and rot in this area. This course, therefore, covers how to prevent fraud, how to detect fraud, the tools to investigate fraud, and how to gather information, and how to prepare a case for prosecution as it relates to the insurance industry.

This course gives fraud professionals the necessary tools required to monitor and clesn the rot that pervades the insurance industry. Regulatory practitioners would have the ability to protect the economy from internal fraudulent activity such as Agent/Broker premium diversion, re-insurance fraud, and rented asset schemes. The program also covers external fraud activities such as fake insurance companies, offshore/unlicensed internet companies, staged auto accidents, viatical and senior settlement fraud.

This course utilizes a mixture of presentations, discussions, case studies, videos, role-plays and interactive exercises to transform participants’ knowledge into hands-on practice. It is epected that, by the end of the course, delegatess 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

 

Venues	Dubai	Dublin	Edmonton	Ghana	London	Nigeria
Dates	TBD	TBD	TBD	TBD	TBD	TBD
Cost	$3,800 per participant (USD)					(=N=)

 

For whom:

Regulators in the Financial Sector

• Insurance Specialists

Compliance Officers, Team Leaders, and Managers

Regulatory Members of Staff

• Regulators of Foreign Exchange Markets and Operations
• Financial Crime & Fraud Prevention Employees

Snapshot of course 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