Insurance Fraud Risk Management

Governance, Policies, Internal Controls, and Regulatory Reporting in Accordance with SAMA Requirements

Duration: 2 Days
Training Hours: 12 Training Hours
Target Audience: Risk and Compliance Managers, Heads of Anti-Fraud Committees, and Executive Managers in Insurance Companies
Delivery Mode: In-person / Live Online

Detailed Learning Objectives

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

• Design an integrated insurance fraud risk governance framework that complies with the Saudi Central Bank (SAMA) regulatory requirements.
• Develop auditable internal policies and procedures covering the entire insurance claim lifecycle, from underwriting through claims settlement.
• Assess gaps in existing internal control systems and prioritize remediation using a risk-based approach.
• Prepare periodic fraud reports for senior management and regulatory authorities in accordance with applicable disclosure and reporting standards.
• Foster a strong anti-fraud organizational culture through awareness programs and effective internal reporting mechanisms.

Key Topics

• Insurance Fraud Risk Management Framework: COSO, ISO 37001, and SAMA’s regulatory requirements for fraud prevention and management.
• Fraud Risk Assessment: Industry fraud risk mapping, risk assessment methodologies, and Key Performance Indicators (KPIs).
• Integration of Fraud Risk Management with AML/KYC Frameworks: Aligning anti-fraud controls with Anti-Money Laundering (AML) and Know Your Customer (KYC) requirements within insurance companies.
• Regulatory Reporting and Disclosure Requirements: Periodic regulatory reports, suspicious activity reporting, and supervisory expectations.
• Internal Fraud Awareness Programs and Whistleblowing Mechanisms: Establishing effective ethics reporting channels and promoting a culture of integrity and compliance.