How Can Insurance Adjusters Prevent Fraud?
- March 13, 2023
- Posted by: April Hilbert
- Category: Best Practices Claims Adjuster Claims Management eLearning
Fraud is a major problem in the insurance industry, costing the industry billions of dollars each year. It’s important for new insurance adjusters to be aware of the different types of fraud that can occur and take steps to prevent it from happening.
First, it’s important to understand what fraud is. In short, fraud is any intentional deception or misrepresentation made with the goal of gaining something at someone else’s expense. Insurance fraud occurs when someone makes false statements or withholds information when filing an insurance claim in order to get money they are not entitled to. The most common types of insurance fraud include workers’ comp claims, medical billing scams, and auto insurance fraud.
Fortunately, there are ways that insurance adjusters can help prevent fraud from taking place in the first place.
Here are some steps you can take to prevent fraud:
- Verify all submitted documents and ask for additional evidence if needed.
- Interview witnesses, if appropriate, and check their credibility by verifying identities and other personal information.
- Look out for suspicious patterns such as multiple similar claims being filed or unusually high policy values.
- Keep up-to-date with industry trends and know what kinds of activity should raise red flags.
- Use technology tools such as data analytics to detect patterns that may indicate potential fraudulent activity.
If you suspect any kind of insurance fraud, it’s important to report it immediately. You should notify your supervisor and contact your state’s department of insurance as soon as possible so they can investigate the matter further. It’s also beneficial to consult with legal counsel before making any reports, so you have a better understanding of your rights and responsibilities during an investigation. Typically, the carrier you work for will train you on their specific procedures and industry best practices when dealing with fraud. We hope these tips help you feel more confident navigating your role as an insurance adjuster.
If you are looking for continuing education courses that don’t just meet the CE requirements but are actually helpful in equipping you with the skills and knowledge you need, sign up for AE21’s Claims Training and Continuing Education courses today to find out how we can equip you in your career as an Insurance Adjuster.