A Brief Overview of Insurance Investigation

Name: A Brief Overview of Insurance Investigation
Rating: 4.5 (40 reviews)

Explore the qualification requirements, job description and actual cases of an insurance investigator

Created byLinda van der Westhuizen

Last updated 1/2024

English

What you'll learn

Gain an understanding of what an insurance investigator does and what type of cases they work on
We also discuss the requirements and qualifications needed to be an insurance investigator
Examples of real cases involving fraud are presented in the course
Learn about syndicates and individuals who commit fraud

Course content

5 sections • 11 lectures • 52m total length

Introduction1:30
In this free talk I provide you with an understanding of the field of insurance investigation and we discuss what qualifications are required of investigator and what their day to day work involves.
I also discuss some of the cases that I have worked on in the past and share insight into how individuals and syndicates perpetuate fraud. In my experience, people enjoy this very much and often want to learn more!

Introduction and disclaimer0:38
I note my disclaimer regarding certain information related to the past cases and investigations I have worked on
Parastatal investigations11:20
This clip will give you an understanding about a particular parastatal fraud case I was involved in. I give some insight into what went wrong and what institutions can do to prevent similar syndicate activity.
Motor vehicle fraud5:55
Fraud with regards to motor vehicles occurs in multiple ways. There can be misrepresentation around the circumstances of the accident or theft of the vehicle. I discuss syndicate fraud with regard to the theft of vehicles as well as how individuals attempt to abuse their insurance.
Medical reviews4:37
Reviewing the reasons for hospitalization by studying medical documents them is an important factor in preventing abuse of medical insurance products. I share with you my experiences with individuals who commit fraud as well as how doctor and patients collude for the purpose of fraud
Syndicate activity10:53
Here we discuss the difference between new syndicates who are not yet evolved and those that are very sophisticated.

Reasons we need to assess claims effectively1:31
Apply a logical, methodical mindset to assess insurance claims by corroborating client details, red-flagging discrepancies, critically analyzing evidence, and reporting findings to confirm or refute suspicions.
Case study for a gastrointestinal condition2:56
examine a case study of a 48-year-old woman admitted for five days with abdominal pain, diarrhea, and cramps, where non-life threatening symptoms favor outpatient management.
Document tampering and fabrication5:47
Examine falsification of admissions and document tampering through real KwaZulu-Natal case studies, and identify red flags such as inconsistent medications, abnormal results, handwriting changes, and icd ten coding alterations.

Thank you!1:20
Thank you for taking the time to listen to this talk. I know that you will see how valuable my expertise and experience are and if you work in the field of insurance and want to broaden your knowledge base, check out the other courses I have developed that will help you to grow professionally and give you the edge!
I invite your recommendations for future content and courses, if you would like information on a specific subject or area of fraud please get in contact and let me know! I will do my best to create content that if filling the knowledge gaps that exist.

I wish you all the best with your career and hope you enjoyed the journey into my professional world!

Requirements

Interest in insurance investigation

Description

Welcome and thank you for joining me this free talk! I provide you with an understanding of the field of insurance investigation by sharing some of the cases I have dealt with in the past and these include examples of individuals who abuse insurance products or commit fraud as well as how both new and sophisticated syndicates operate and what weaknesses they exploit for the purpose of fraud. These examples included examples of medical or health related fraud as well as those related to motor vehicle accident or theft claims.

We discuss what qualifications are required of investigator and while having studied into the field of forensics and/or criminology is beneficial, it is not the only way to get into the field. Experience and being willing to learn as you go are also ways to get into this exciting line of work.

I share with you the day to day work of an insurance investigator and this includes verification and validation of information as well as gathering of evidence to prove or disprove a specific rea of concern.

The talk is presented in a conversational way, so please grab a cup of coffee or tea and sit back and have a listen. It is my passion to teach all I have learnt and to share my findings and insights from actual investigations I have worked on. I know you will enjoy the talk and hope that if you are an assessor or investigator and want to broaden your knowledge base, you will check out the courses I have developed to help you grow professionally.

Who this course is for:

Assessors
Loss adjustors
Investigators
Insurance investigators

A Brief Overview of Insurance Investigation

What you'll learn

Explore related topics

Course content

Introduction1 lecture • 2min

Qualifications and job descriptions for insurance investigators1 lecture • 6min

Past cases5 lectures • 33min

Bonus videos for medical / health care assessors3 lectures • 10min

Conclusion1 lecture • 1min

Requirements

Description

Who this course is for: