Insurance Fraud Investigation

Bucharest 18 September 2019

Trainer: Andrea Shiakalli

Details

Fraud is a phenomenon affecting every organization across the world. As fraudsters become more sophisticated and come up with new methods, it is imperative to equip yourself with the necessary knowledge and tools in the fight against fraud.

The seminar aims to enhance the participants’ knowledge about legal considerations, document collection, interviewing skills and evidence documentation, in order to prepare them to lead an investigation with accuracy and confidence.

The topics covered will focus on the areas of health and goods insurance.

Target group

The seminar addresses to professionals working in the insurance industry, with emphasis on health and goods insurance:

managers and staff;
underwriters;
claims adjusters;
internal auditors;
insurance agents

Course objectives

The main objectives that the trainer has set:

Gain insights on the various types of insurance fraud, including applications of frauds and claims frauds, as well as the red flags that could be an indicator of insurance fraud;
Discussing the procedures for conducting an insurance fraud investigation and examining the related legal issues;
Presenting case studies to allow the participants to practice the skills learned in the seminar.

Subjects

Introduction

Definition of Insurance Fraud
Understanding criminal behavior
Fraud schemes
“Red Flags” of Insurance Fraud

The Insurance Investigation Process

The Law related to fraud
Sources of Information
Evidence Retrieval

Establishing a Special Investigation Unit

Internal and external fraud reporting
Fraud manuals, policies and procedures
Fraud response plan

Workshop

Interviewing Techniques
Case studies

Trainer

Andrea Shiakalli, BSc, MBA, LLM, CFE

Andrea is an experienced fraud and forensics investigator with an established track record of successful investigations and discovery of fraudulent activities. She is able to consistently spot and uncover behaviors and patterns that indicate fraud.

Andrea has worked in the insurance and telecom industry performing several investigations. Currently she works as a Freelancer on Fraud Investigations, Fraud Risk Management and Forensic Accounting. She is a member of the Cyprus Society of Criminology and member of the Association of Certified Fraud Examiners.