Insurance Fraud Detection & Prevention

A specialized program that equips participants with the practical tools and methodologies required to detect fraud patterns early across various insurance lines, including motor, health, property, and life insurance. The program also enables participants to build an effective fraud control framework that complies with the requirements of the Saudi Central Bank (SAMA) and minimizes losses resulting from fraudulent insurance claims.

Detailed Learning Objectives

By the end of the program, participants will be able to:

• Identify common fraud schemes and techniques across different insurance lines in accordance with the Saudi Central Bank (SAMA) regulatory framework.
• Develop a practical Red Flags Matrix for the early detection of suspicious insurance claims.
• Apply preliminary investigation procedures for suspicious claims prior to settlement while ensuring proper legal documentation.
• Design effective coordination mechanisms among underwriting, claims, and compliance departments to facilitate information sharing and fraud prevention.
• Utilize data analytics systems and digital technologies to automatically detect fraudulent patterns and anomalies.

Key Topics

• Regulatory Framework: SAMA regulations and fraud risk management requirements for the Saudi insurance sector.
• Motor Insurance Fraud: Staged accidents, collusion, and inflated repair estimates.
• Health Insurance Fraud: False medical claims, fraudulent diagnoses, and policy/document sharing.
• Property Insurance Fraud and Arson: Detection techniques and evidence documentation.
• Automated Anti-Fraud Systems: Claims data analytics and fraud detection technologies.
• Case Studies: Real-world fraud cases and lessons learned from the Saudi and GCC insurance markets.