NATIONAL INSURANCE ACADEMY

PUNE

P687 – PROGRAM ON INSURANCE FRAUD DETECTION AND PREVENTION

(2022-23)

 Background:

 The financial sector has been witnessing increasing number of frauds leading to losses to companies to the tune of thousands of crore.  The nature of frauds has also undergone changes in tune with changes in the composition of the society, attitude of the people, improved technology etc.  Cyber Crime has gained much ascendance in the last few years.  The insurance sector is no exemption to the frauds that are taking place in the financial sector.

 The frauds that have been perpetrated have raised doubts on Corporate Governance, Business Ethics, Auditor’s role, Regulator’s role etc.  Hence every stakeholder needs to be alert and play his/her role effectively and help companies to detect such frauds.

 IRDAI regulations and organisational guidelines on detecting and preventing Insurance frauds need to percolate to bottom of the pyramid so that there is an organisational fight against this organised crime.

 Objectives:

 Ø  To learn about Insurance Fraud scenario in our country

Ø  To learn about IRDAI regulations and corporate guidelines for Fraud mitigation

Ø  To learn about Fraud detection and prevention tools

Ø  Educating participants about the potential areas of frauds

Ø  Introduction to cybercrime and cyber laws

 Contents:  

Ø  Fraud Scenario in Insurance sector (worldwide)

Ø  IRDAI Corporate Governance Guidelines

Ø  Regulatory Framework for prevention of Insurance frauds

Ø  Risk Management Systems and processes

Ø  Role of internal operating procedures in preventing frauds.

Ø  Cyber frauds threats (Role of technology and social media)

Ø  Money Laundering in Insurance including AML/CFT/FATKA,

Ø  Intelligence and Investigating tools & techniques in insurance Frauds.

Ø  Principles of Insurance & analysis of Claims Processing Procedure & Insurance Fraud

Ø  Role of internal audit & inspection in detecting and preventing frauds.

Ø  Forensic Audit

Ø  Data Mining & Analytics in Fraud Mitigation

Ø  IT Act 2000/2008

Ø  Information Security (Policies & Safeguards)

Ø  Anti-Fraud Policy of LIC

Ø  Whistle blower policy & Integrity Pact

Ø  Case studies and group discussion

Ø  Role of an Claim Investigating Officer

 Participants Profile-

 Manager (Claims), Manager (CRM), Manager (F&A) & Manager (P&IR) to be nominated by the respective Zonal HRDs

 Duration-        3 days

 Dates:             19.12.2022-21.12.2022