Course Introduction

MODULE 1 – INTRODUCTION TO INSURANCE FRAUD INVESTIGATION

This module covers insurance fraud-related topics like purpose, various types of insurance fraud, and the role of insurance fraud investigators. You will also learn about the significance of an insurance fraud investigation to fight fraudulent activities, ensure the smooth functioning of the insurance industry, and protect consumer interests. The module also highlights ethical considerations to follow while carrying out insurance fraud investigations.

MODULE 2 – INSURANCE CLAIMS PROCESS

In this module, you will learn about insurance claims, types of claims, the crucial role insurance fraud investigators play, and procedures to file insurance claims with accuracy. This module also covers common causes of fraudulent claims and equips you with knowledge to identify red flags and effectively investigate and prevent insurance fraud.

MODULE 3 – POLICY: THE CONTRACT

This module covers basic concepts about insurance policies, such as legally binding contracts, the language and structure of policies, and the difference between first- and third-party policies. You will also gain insights about the concept of innocent co-insured parties and will be able to explain their rights within the insurance contract framework, along with knowledge of the legal angle of insurance policies.

MODULE 4 – INVESTIGATIVE TECHNIQUES AND TOOLS

In this module, you will learn the tools needed for insurance fraud investigations, specific investigative techniques, technology usage like data analytics and predictive modeling to identify fraudulent patterns, and interview and interrogation skills to extract crucial information as evidence during an investigation. These skills will help you understand investigative methodologies precisely.

MODULE 5 – DOCUMENTATION AND REPORTING

This module covers features of insurance fraud investigation documentation and reporting, techniques to gather information within a legal framework, documentation requirements specific to insurance fraud investigations, and skills for writing detailed investigation reports. You will also gain proficiency in effectively presenting your findings to stakeholders, along with ethical considerations to maintain truthfulness in your work.

MODULE 6 – CONDUCTING SURVEILLANCE

This module explores surveillance techniques (foot surveillance, vehicle surveillance, fixed surveillance, and even satellite and night surveillance), surveillance methods, and surveillance preparation. You will also learn about the importance of vendor management in equipping you with the skills and knowledge to efficiently coordinate and use external resources when conducting surveillance operations.

MODULE 7 – LEGAL ASPECTS OF INSURANCE FRAUD INVESTIGATION

In this module, you will gain an understanding of legal principles, laws in context to insurance fraud investigations (statutes and regulations), and how case law and judicial precedents help shape the legal framework for investigations. The module also outlines evidence collection and preservation procedures so that you, as an investigator, stick to legal standards throughout your work.

MODULE 8 – CASE-ORIENTED INSURANCE INVESTIGATION

This module explores specialized areas of insurance fraud investigation, like fraudulent disability investigations, motor vehicle accident investigations, premise accident investigations, railroad crossing investigations, suicide investigations, accident reconstruction fundamentals, fire and explosion investigation techniques, the need for photographing while documenting evidence, and different scenarios you may encounter.

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