Insurance Fraud Investigator Miami Beach South Beach
Insurance fraud is any act committed with the intent to obtain a fraudulent outcome from an insurance process. This may occur when a claimant attempts to obtain some benefit or advantage to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due. According to the United States Federal Bureau of Investigation, the most common schemes include Premium Diversion, Fee Churning, Asset Diversion, and Workers Compensation Fraud. The perpetrators of these schemes can be both insurance company employees and claimants. False insurance claims are insurance claims filed with the intent to defraud an insurance provider.
Insurance fraud has existed since the beginning of insurance as a commercial enterprise. Fraudulent claims account for a significant portion of all claims received by insurers and cost billions of dollars annually. Types of insurance fraud are diverse and occur in all areas of insurance. Insurance crimes also range in severity, from slightly exaggerating claims to deliberately causing accidents or damage. Fraudulent activities affect the lives of innocent people, both directly through accidental or intentional injury or damage, and indirectly as these crimes cause insurance premiums to be higher. Insurance fraud poses a significant problem, and governments and other organizations make efforts to deter such activities.
Fraud is a problem that can be faced by any corporation or business. It may take years or decades before it is realized that this is taking place. When a lot of people are involved it makes it hard to know what is going on. If you are having suspicions and you want to be sure of what is going on in your company, you should hire an investigator. Here are the qualities of a fraud investigator people should consider before hiring.
Honesty and good morals are some of the important qualities of good investigators. With these qualities, it is easy to trust them, which is important so that you can be comfortable when it is time to share private information in the process of investigating. When they are honest and have upright morals in their conduct it makes it easy to trust them and their work.
A fraud investigator is someone who investigates forgery and theft within customers’ accounts and transactions on behalf of a bank or a financial institution. They track and monitor the bank’s transactions and activity that comes through the customers’ accounts. It is their job to identify and trace any suspicious or high-risk transactions, determine if there is improper activity involved, and determine if there is any risk to the bank or its customers.
A fraud investigator is responsible for observing various customer transactions to flag or identify suspicious activity. Most accounts and customers have banking patterns that typically do not change over the long term. Any transactions or series of transactions that do not fit the expected activity generate a 'red flag', and will be looked at by a fraud investigator.
If any suspicious transactions are found, the fraud investigator will flag the account and keep it suspended until it can be checked and verified. Transactions can be looked at for any number of reasons: transaction type, transaction amount, unusual transfers to unlikely partners, places where transactions originate, or a flurry of activity beyond the accepted norm for the account.
For any suspicious transactions, the fraud investigator (typically an officer of the bank) will try to obtain information that can support the origin of the transaction. For fraudulent items, this information can bear out who perpetrated the fraudulent item and is responsible for the criminal activity in question. The analyst will contact the bank branch, the account holder, and any other intermediate parties that may have come in contact with or handled the questionable item. They are responsible for keeping any collected information confidential while working to catch the criminal(s) who may have committed the felony.
The fraud investigator must also keep models for analyzing fraud within the bank’s regions. This can help determine patterns of fraud over certain areas, and break down larger criminal rings responsible for fraud activity. This can also help to identify certain holes in security that can be targeted over time so that the bank can identify system improvements that can be made to eliminate the risk of fraud or reduce the ways in which it can occur. The investigator may even have a say in software tools that can work towards detecting fraud and preventing it from occurring, or reporting security threats and suspicious activity quickly.
The typical workplace for a fraud investigator is typically in a corporate office environment if not working as a freelancer. The fraud investigator will typically be in a regional or central office, where he or she can monitor activity from multiple sources at once. At a moment’s notice, the fraud investigator may be able to access any type of data needed to investigate the troublesome activity.
A fraud investigator specializes in investigating suspicious activities that could potentially include fraud. Fraud investigators often work with law enforcement officers, and they have an expansive knowledge of finance and relevant computer programs to perform their job. The job responsibilities of a fraud investigator include researching criminal fraud methods and tools, tracking financial data, creating reports, identifying and investigating possible fraudulent activities, and developing techniques and tools useful in the prevention of fraud. Fraud investigators are responsible for tracking criminal fraud, which may involve monitoring financial transactions and analyzing the data retrieved for irregular patterns. Fraud investigators work in a variety of industries, but they usually work in a private institution such as a bank.
Fraud investigators must continuously educate themselves on the latest advances in the field of fraud prevention, as well as on methods used by criminals to access financial information. New technology is essential for fraud investigators, so they must stay up to date with relevant advances in technology.
The educational minimum for most fraud investigator positions includes a bachelor's degree in finance or a related field. Some employers will substitute several years of experience in lieu of a degree. Fraud investigators working with a bank usually receive training from their employer as well. An eye for detail, good problem solving skills, strong organizational skills, and an analytical mind are essential. Excellent oral and written communication skills are necessary, as they are often required to interact with customers and other stakeholders on a regular basis.
In any investigation, research is crucial, when looking for an investigator, you should ensure they have quality research skills. They should be experts at gathering information. They should also be able to do this in a strategic manner and carefully evaluate it before they present their findings. This will help the investigation to be completed within a short period of time and will also save the client money.
Knowledge of the law and that of the legal area that the detective is working on is very important. This includes the ability to handle witness statement, a theft case at the company and a combination of various legal areas in a fraud case. He or she should also be licensed, find out if they are at the office of your commissioner.
A good relationship between the investigator and the client is important. Good communication will help in developing a good relationship between the two of you. The detective should be able to communicate effectively with you as the client and also with the staff involved. The fact that the individual is a representative of you, it is important that he or she be courteous when conducting the investigation.
The skills and knowledge that the investigators must have in the investigation field should be exceptional and of high level. They must be able to perform at their level best the task you present to them. They should have done an on the job training; a course certificate is not enough to give them exposure to the detective field. The training helps in gaining knowledge of new skills and helps them advance their existing ability.
Experience is good in the investigative field, even with the course certificate and training, the experience is important. An investigator who has spent a lot of time in one field has enough knowledge and understanding. That is why an experienced person is more likely to save you time and money because of their familiarity with the work.
After the investigation is complete you want quality findings. To ensure that you have this you must find the right person to do the job for you. You should find someone who you can trust. Even though you will be looking for the best qualities you should trust your judgment at all times, at the end of the day you want someone you are comfortable with.
Whether you are a policyholder or a shareholder in an insurance company, insurance fraud affects you. The field of insurance is wide and fraud exists in every area. Therefore, in this article, we are going to focus in on one of the most important types of insurance – life insurance. We will look at the major types of life insurance fraud and how they affect your bottom line.
Insurance fraud comes in two main categories: seller fraud and buyer fraud. Seller fraud occurs when the seller of a policy hijacks the usual process, in a way that maximizes his or her profit. Buyer fraud occurs when the buyer bends the process to obtain more coverage or claim more cash than he or she is rightly entitled to.
Almost everyone is familiar with insurance fraud. We've all heard the stories of people who received millions after a car accident or the heartless insurance firm refusing to pay out to a widow on a technicality. Insurance fraud is one of the oldest types of fraud ever recorded, dating back to 300 B.C., when a Greek merchant sunk his own ship, in an attempt to cash in on the insurance, and drowned in the attempt.
Whether you are a policyholder or a shareholder in an insurance company, insurance fraud affects you. The field of insurance is wide and fraud exists in every area. Therefore, in this article, we are going to focus in on one of the most important types of insurance – life insurance. We will look at the major types of life insurance fraud and how they affect your bottom line.
It Takes Two to Tango
Insurance fraud comes in two main categories: seller fraud and buyer fraud. Seller fraud occurs when the seller of a policy hijacks the usual process, in a way that maximizes his or her profit. Buyer fraud occurs when the buyer bends the process to obtain more coverage or claim more cash than he or she is rightly entitled to.
Types of Seller Fraud
There are many variations of seller fraud, but they all center around four basic types. These are:
Ghost Companies: In the ghost company scenario, policies are issued and premiums accepted from policyholders, but the company underwriting the policy isn't legitimate and often doesn't exist. These outright frauds are a type of boiler room operation, where a team of high-pressure scam artists dials likely victims to sell them false policies. Unfortunately, the fraud isn't usually discovered until someone tries to file a claim on the policy their family member thought was in effect, in the event of his or her death.
Premium Theft: The premium theft scenario is when the insurance rep accepts premiums, but doesn't submit them to the company underwriting the policy, thus invalidating the policy. In this case, the agent essentially pockets the money. Premium theft has become less of an issue as more companies have moved towards direct deposit models, but it is still possible in some cases.
Churning: Churning refers to a situation where the insurance rep advises the customer to cancel, renew and open new policies in a way that is beneficial to him or her, instead of beneficial to the client. This type of insurance fraud often targets seniors and is driven by the agent's desire for larger commissions. Churning keeps a portfolio constantly in flux, with the primary purpose of lining the advisor's pockets.
Over or Under Coverage: Similar to churning, under or over coverage occurs when an insurance rep convinces customers to buy coverage they don't need, or sells a lesser policy and represents it as a complete policy. In either case, the rep is trying to maximize commissions and ensure the sale, rather than focusing on meeting the client's needs.
Types of Buyer Fraud
Buyer fraud also comes in a number of different flavors, but they all center around a theme of dishonesty. Basic types of buyer fraud include:
Post-Dated Life Insurance: Post-dated life insurance refers to a policy that has been arranged after the death of the person being insured, but appears to have been issued before death. This type of fraud is usually carried out with the help of an insurance agent. It is also one of the easier types of fraud for insurance companies to detect because record keeping has become more stringent.
False Medical History: Falsifying medical history is one of the most common types of insurance fraud. By omitting details such as a smoking habit or a pre-existing condition, the buyer hopes to get the insurance policy for cheaper than he or she would have otherwise been able.
Murder for Proceeds: There are two versions of the murder for proceeds fraud. In the first, the insured doesn't know they are insured and are understandably surprised to be murdered. In the second, the policy is legitimate and was taken out in better times, however, financial hardships lead the perpetrator to decide that killing his or her spouse/family member/business partner, for the money, is the best way out of the problem.
Lack of Insurable Interest: As with murder for proceeds, insuring people you shouldn't be insuring, in hopes that they will die, constitutes fraud. Insurance is founded on the idea of protecting people from financial loss, so using it to gamble on lives for a financial gain is a perversion of the system. This includes viatical settlements, which combine non-insurable interest with falsified policies taken out on the terminally ill.
Suicidal Accidents: Just as financial hardship can lead otherwise rational people towards murder, the same factors can lead people to commit suicide in a way so it looks accidental. This constitutes fraud in that it is an intentional act for the purpose of collecting the insurance proceeds, and would not have occurred if those proceeds did not exist. This can be a very difficult one to detect, as the medical examiner has final say in accidental death. Even if it is clearly a suicide, the claim centers on the state of mind, rational or not, at the time of suicide.
Faking Death or Disability: Many life insurance policies have riders for disability, creating the temptation to fake one to get the payout. However, some people take it a step further and fake their own deaths. In both cases, the fraudster has to deal with the possibility of being discovered through an investigation.
The Cost of Insurance Fraud
Just as there are two main types of life insurance fraud, there are also two consequences. When people engage in buyer fraud, it raises the cost of insurance. The reason for this is very simple; insurance companies are really good at modeling, so they tweak their models to account for buyer fraud and then spread that cost across all their policyholders. In a very real way, every person who tries to stick it to the insurance company ultimately makes your policy cost more.
In contrast, seller fraud can potentially hurt just the select few that experience it. It is, in every essence of the word, bad luck. However, on the whole, every time the insurance company you invest in treats someone badly, it loses business to a company with a better reputation and controls on the agents. As an investor, you will be tempted to move your capital to the better performing company, thus punishing seller fraud in a roundabout way. The internet has also helped reduce seller fraud, as many shady outfits and practices become exposed sooner in the game.
The Wasser Agency located in Miami Beach/South Beach, FL and we offer you all type of resources you need to carry on any investigation with a variety of specialized human resources (investigators) in many fields.