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:

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

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Location:

South Africa

Training Dates:

Each course starts every Monday of each week. Please book your training on a date that is a Monday.

Course Duration:

Unit Standard:

NQF Level:

Number of Credits:

Course Fees

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

How to Apply:

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

NB: Terms and Conditions for Payment and Refunds

1.1. Full payment for the training workshop must be made at least 5 days before the scheduled workshop date.

1.2. Payment can be made via bank transfer, credit card, or any other agreed-upon method.

1.3. A confirmation of payment will be issued upon receipt of funds.

1.4. Any form of Payment means that trainee / delegate / client receiving the training accepts the training and agrees to these terms and conditions.

2. Cancellation and Refund Policy

2.1. Cancellations made 30 days or more before the workshop date will be eligible for a full refund, minus any administrative fees.

2.2. Cancellations made 15 to 29 days before the workshop date will be eligible for a 50% refund of the total payment.

2.3. Cancellations made less than 14 days before the workshop date will not be eligible for a refund.

2.4. Participants who fail to attend the workshop without prior notice will not be eligible for a refund.

3. Rescheduling

3.1. If a participant wishes to reschedule, a request must be submitted at least 14 days in advance, subject to availability.

3.2. A rescheduling fee may apply.

4. Workshop Cancellation by the Organizer

4.1. AATICD reserves the right to cancel or reschedule the workshop due to unforeseen circumstances, including but not limited to low enrolment, trainer unavailability, or force majeure events.

4.2. In the event of cancellation by AATICD, participants will be offered a full refund or the option to attend a rescheduled session.

4.3. AATICD is not responsible for any additional costs incurred by participants, such as travel or accommodation expenses.

5. Refund Processing

5.1. Approved refunds will be processed within 7 business days from the date of cancellation approval.

5.2. Refunds will be issued using the original payment method unless otherwise agreed.

6. Contact Information

For any questions regarding payments and refunds, please contact us at:

Email: apply@aaticd.co.za

Phone: +27 73 016 5042

By registering for the workshop, participants agree to abide by these terms and conditions.

In-House Trainings are also available for 3 or more delegates for any duration. Please consult with our Administration for such In-House training bookings.

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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