- Job opportunities
- Course Outline
- Required Texts
- Examination/Test
Associate Certificate + CIIP
Job opportunities
Introduction
We currently offer the unique and pioneering Associate Certificate, Global Insurance Fraud Education (GIFE) to every member (student, adjunct, and full members) of the Global Insurance Anti-Fraud Professionals (GIAP). The GIFE certificate covers the subject areas: life, health, and travel insurances. These insurances and the claims therefrom transcend borders and are global.
The essence of the certificate is to provide knowledge and skills to the holder to be able to examine and investigate life, health, and travel insurance claims anywhere around the world and report professionally on their findings. Most importantly, it is for them to be able to ferret fraud whenever suspicious claims are presented to them.
Job opportunities
The job and employment opportunities available to the holder are as follows:
- You can secure work with the local and global insurance companies underwriting life, health, and travel insurance risks.
- You can work as an Analyst/Investigator or Investigative Auditor with Healthcare Facilities, Health Maintenance Organizations (HMOs), Mutual Health Associations (MHAs), and Third-Party Administrators (TPAs), locally and internationally.
- You can effectively and efficiently examine and investigate Defense Base Act/Administration’s insurance claims, particularly those on Post-Traumatic Stress Disorder (PTSD) and other mental health syndromes.
- You can work with investigative firms/agencies offering life, health, and travel insurance investigative solutions locally and worldwide.
- You can seek work with offices of insurance attorneys and legal advisers locally and internationally.
- You can work with large businesses and major national corporations that process life, health, and travel insurance claims in-house while their insurance underwriters audit them periodically.
- You may opt for self-employment and seek investigative assignments and consulting work with insurance companies, investigative firms/agencies around the world.
Study 5 books + Take 1 Exam/Test = 2 Certificates = Global career!
Course Outline
A. Introduction to Insurance and Investigation
Objective: The objective is to expose the candidate to the basic principles and practice of insurance. You cannot present yourself as Certified Insurance Investigation Professional (CIIP) if you do not have at least a smattering knowledge of the basic principles, practices, and the coverage of the major insurance policies. There is also the need to understand the essential personal qualities required of the Insurance Investigation Professional.
Principles and Practice of Insurance
Who is an Insurance Investigator?
Essentials of an effective Insurance Investigator
B. The Psychology of Insurance Fraudsters
Objective: There is the need to understand why an individual would resort to filing fraudulent insurance claims. Often, some investigators deem one to be highly placed in the society and therefore have unquestionable reputation. This invariably leads them to give the individual the benefit of doubt and not conduct detailed investigations about their claims. Our experience shows that all manner of professionals and persons including a Bishop in one instance and several self-professed pastors have been proven to have filed fraudulent claims.
C. Introduction to Global Insurance Fraud Education (GIFE)
Objective: The objective here is to introduce the candidate to global life, health, and travel insurance fraud. This is important before detailing how you can uncover fraud and the specific categories of fraud in the next chapter.
- Global Life Insurance Fraud
- Global Health Insurance Fraud
- Global Travel Insurance Fraud
D. Examining and Investigating Fraudulent Life Claims | Life Insurance Fraud Schemes
Objective: It is essential for the candidate to be educated on the common life insurance fraud schemes. If you do not have the knowledge, there is the tendency to overlook obvious red flags when they are stirring you in the face. These schemes are discussed with case notes drawn from claims investigated around the world for easy comprehension.
Common Life Insurance Fraud Schemes
Also, read the book: Uncovering Fraudulent Foreign Life Insurance Claims – Vol. 1 (Incorporating lessons for Claims Examiners and Investigators worldwide)-
ISBN 978-0-9912350-1-8 | 160 pages
- False Documentation
- Body substitution
- Drowning
- Motor Vehicle Accident / Road Traffic Accident
E. Examining and Investigating Fraudulent Health Claims | Health Insurance Fraud Schemes
Objective: Here, the candidates study the various health insurance fraud schemes perpetrated by claimants. These are claims filed with insurers, Health Maintenance Organizations (HMOs), and under the Emergency Medical Expenses (see Travel Insurance Claims below) around the world which are proven to be fraudulent. However, the claims are filed primarily with insurance companies and organizations in the United States, Canada, Europe, Asia, and the Middle East.
Categories of Fraudulent Health Insurance Schemes
Also, read the journal: JOURNAL OF GLOBAL INSURANCE FRAUD EDUCATION , pages 50-88 | ISSN 2324-0225
- The medical provider does not exist
- Fabricating documents of existing medical providers
- Physician providers collusion with claimants
- Worldwide fraudulent PTSD and mental health claims
Indicators of Fraudulent Foreign Health Insurance Claims
Also, read the book: Indicators of Fraudulent Foreign Health Insurance Claims (Analyses of 53 indicators of fraudulent foreign health insurance / medical expenses claims distilled from over 5,000 fraudulent claims investigated in Africa, Asia, South America, Central America, the Caribbean, and the Middle East for insurers, HMOs, and travel insurance companies in the United States, Canada, Europe, and Asia. They are enhanced With pictures and checklists of medical equipment for Claims Examiners and Investigators worldwide). – ISBN 978-0-9912350-0-1 | 163 pages
F. Examining and Investigating Fraudulent Dental Claims
Objective: Dental Claims are not frequently filed with insurance companies, et al. They are filed by those who hold specific dental policies but more often under the Emergency Dental Expenses (EDE) covered in travel insurances (see Travel Insurance Claims below). Often, the claimants take policies to cover EDE when they had prior dental problems. However, EDE only covers such treatment borne out of an emergency as acute injury to the teeth.
Dental Fraud: Investigating Dental Claims
- Introduction
- Emergency dental treatment
- What is required of the Investigator
- Indications of dental fraud
- Use of Dental Consultant
G. Examining and Investigating Fraudulent Travel Claims
Objective: The candidate is expected to study the various policies under travel insurances and the types of fraud associated with each. These claims are discussed with various case notes from claims investigated around the world. Thus, whether you are a Claims Examiner or field Investigator you will gain insights into what documents to seek and how the claims are investigated to uncover fraud.
Travel Insurance Fraud:
- Accidental Death & Dismemberment – Travel Accident
- Emergency Medical Expenses
- Fraud associated with medical tourism
- Emergency Dental Fraud
- Baggage, personal effects, and money loss
- Rental Car Damage and Loss
- Trip Cancellation or Interruption
- Personal/Public Accident Liability
- Fraud associated with assistance companies, air medical ambulances
H. How to write effective insurance investigation reports
Objective: At this stage, you are almost ready to become a true professional. Every Certified Insurance Investigation Professional (CIIP) is expected to be able to write effective insurance investigation reports. This is what marks the CIIP as the true professional. The 267-page manual guides you to write the reports which your direct principals will be satisfied with that the investigation was well-rounded and presented. Also, all the other possible investigative report audiences/readers; namely, co-insurers, reinsurers, insurance attorneys, legal advisers as well as judges and juries would applaud the investigation and report.
Further, in the book, there are samples of redacted letters presented to the various agencies such as the hospital, Police, Civil Registry, funeral home, cemetery management, crematory management as well as redacted reports which offer good lessons.
Report Writing for Insurance Investigators
Also, read the book: Effective Report Writing Manual for Insurance Investigators | ISBN 978-0-9912350-6-3 | 267 pages
- Essentials of an insurance investigation report
- Life Insurance Investigation Report
- Health Insurance Investigation Report
- Travel Insurance Investigation Report
- Samples of letters
- Samples of reports
I. Embarking on the profession and career
Objective: This is a new profession that never existed previously. As a result, it is imperative for those who pioneered and nurtured the profession to share their experiences. This will help the candidate to gain greater appreciation of the personal qualities to develop if they choose to make a career in the profession.
Elevating insurance investigation to a profession and a career
Required Texts
The compulsory reading texts or publications provide the candidates the basic knowledge they require to be able to pass the examination/test. They are presented to the candidates upon registration and are as follows:
1. Global Insurance Fraud Education (GIFE)
Course Outline and Texts (2022/23)
ISBN 978-0-9912350-5-6 softcover | >800 pages
Price: USD125.00
(Available only to GIAP members)
2. Journal of Global Insurance Fraud Education
ISBN 2324-9225 (Print)
ISBN 2324-9242 (Online)
By Global Insurance Anti-Fraud Professionals
Softcover, 100 pages | Price: USD30.00
Contents: Analyses of 17 fraudulent life, health, and travel insurance claims investigated in Turkey (2), Afghanistan, Nigeria (3), Haiti, Pakistan (2), Colombia, Argentina, Cameroon, Iraq, Mexico, Dominican Republic, Russian Federation, Yemen for insurers in Britain, Canada, and the United States. The articles contain lessons for Claims Examiners And Investigators.
3. Uncovering Fraudulent Foreign Life Insurance Claims - Vol. 1
(Incorporating lessons for Claims Examiners and Investigators worldwide)
ISBN 978-0-9912350-0-1-8 / 160 pages / Price: USD75.00
Contents: Analyses of 15 fraudulent life insurance and accidental death claims investigated in Afghanistan, Nigeria (3), Cameroon, Guyana, Ghana, Bangladesh, Tanzania, Iraq, Haiti, Angola, Zimbabwe, India, and Moldova, for insurers in Britain, Canada, and the United States.
4. Indicators of Fraudulent Foreign Health Insurance Claims
ISBN 978-0-9912350-0-1 / 163 pages / Price: USD75.00
Contents: Analyses of 53 indicators of fraudulent foreign health insurance/medical expenses claims investigated in Africa, Asia, South
America, Central America, the Caribbean, and the Middle East for insurers, HMOs, and travel insurance companies in the United States, Canada, Europe, and Asia. They are enhanced with pictures and checklists of medical equipment for Claims Examiners and Investigators worldwide.
This is custom heading element
ISBN 978-0-9912350-6-3 / Hardcover, 267 pages / Price: USD85.00
Contents: “Insurance Investigators examine and investigate life, health, and travel insurance claims. They are expected to communicate their findings in a report. However, from our experience, many of these investigators neither have the communicative skills nor any idea of the format to utilize in the presentation of their reports. Many are guided to conduct successful investigations but lack the communicative skills to present a professional report.” – Preface. This book solves all the report writing challenges for you. You will not only have an idea of the format but can imbibe the skills to present reports that meet every scrutiny in a court of law.
6. Access to the Anti-Fraud Journal and other articles on the web site
www.insuranceantifraudprofessionals.com.
(Free access) / Value:USD175.00+
7. Quarterly Newsletter: Global Insurance Fraud Case Notes
The quarterly newsletter provides current fraud trends and investigative solutions.
Free access to the Anti-Fraud Journal, books, and publications worth over USD500.00 are supplied to the candidates on registration for membership and the examination/test.
PLUS: GIAP LAPEL PIN or the CIIP LAPEL PIN presented free to every qualified member. This distinguishes you as a member of this unique professional body and a true insurance investigation professional.
Examination/Test
Examination/Test for the award:
The coursework can be completed within six (6) months by well-focused candidates reading on their own. They are expected to pass the test below by earning a score of 75% and above to be awarded the Associate Certificate. Thereafter, the successful candidates can append the designation, Certified Insurance Investigation Professional or simply CIIP by their name. Example:
• John A. Smith, CIIP
Note: Those who are college or university students will be awarded the certificate only. They will not be awarded the CIIP until they complete their degree program and graduate.
Steps to taking the examination/test
The steps for the candidates towards taking the test are as follows:
Step One: Register for Associate membership as a student, adjunct, or full member and for the Associate Certificate + CIIP program
Step Two: On receipt of the five publications as listed in Required Texts, study the materials as per the Course Outline. When you are satisfied that you understand the subjects, you can test your knowledge and do the test below.
Note: You are entitled to two attempts following your payment. Failing after the second attempt, you would require to start all over and register again.
Taking the Test:
The candidates are expected to generate a loss or claim situation on life, health, and travel insurances.
A. Life Claim
You are to generate/develop a claim situation involving the alleged death of a policyholder that you have been engaged with as an Insurance Investigator by an insurance company in your country to investigate.
The claim would be investigated in a foreign country. You opted to instruct another Insurance Investigator in that country to work the case with you.
Or, you have been engaged by a foreign insurance company to investigate a death claim in your country.
The circumstances could be that the alleged death was caused by complications from any of the following:
- natural cause or
- following complications from injuries sustained in a motor vehicle accident or
- a road traffic accident such as involving a motorcycle accident.
The claimant presented the insurance company with the claim documents as follows:
- Medical Certificate of Cause of Death
- Certificate of Death
- Police Investigation Report
- Burial Permit / Certificate
- Cremation Certificate
- Printed obituary poster
- Printed funeral service program
- A video coverage of the funeral and burial events
- Pictures taken during the funeral ceremony
- Authorization to release information and records signed by the beneficiary | The United States’ Health Insurance Portability and Accountability Act (HIPAA) | The European Union’s General Data Protection Regulation (GDPR). (Note, one of these three forms of Authorization is applicable depending on your region or continent).
a) You are expected to utilize at least six of the claim documents/items listed above in developing your investigative steps.
b) Next, write the letters for the various facilities/agencies such as the hospital, civil registry, the Police, crematorium or cemetery, Reverend Minister, Imam, Monk, whichever that is applicable. Thereafter, write the note of instruction for the local insurance investigator.
If you are engaging an Insurance Investigator in the foreign country, then write the note of instruction, list possible red flags in the documents that the Insurance Investigator should attempt to seek the resolution.
c) Determine the possible investigative result with the various facilities such as at the hospital, civil registry, the Police, crematorium, cemetery, the church, and the policyholder’s family.
d) Write your report based on the investigative findings or result at the hospital, civil registry, the Police, crematorium or cemetery, the church, and the policyholder’s family. Your report must capture the pertinent appendices.
The characteristics of the report must be:
- Font or text size: 14
- Line spacing: 1.5
C. Travel Claim
Here, the candidates are to work an investigative assignment on any of these four:
- Baggage, personal effects, and money loss
- Car Rental Damage / Loss
- Trip Interruption / Cancellation
- Personal Accident Liability
a) You are expected to develop the alleged circumstances that led to the loss or claim; and determine the documents that were presented to the insurance company in support of the claim. The principal could be
– a local insurer or
– a foreign insurance company or
– another investigative agency acting for the insurer.
b. Then, write the note of instruction if you are engaging a local insurance investigator in the foreign country. The instruction should contain the investigative steps.
c. Write the letters for the parties on the case such as the hospital, the Police, airline, car rental company, etc.
d. Determine the investigative result or findings noting the play of known fraudulent aspects with respect to the type of travel insurance claim.
e. Write your report based on the investigative findings or result at the pertinent places. Your report should mention the pertinent appendices.
The characteristics of the report must be:
- Font or text size: 14
- Line spacing: 1.5
B. Health & Emergency Medical Expenses Claim
You are expected to develop a typical claim situation under the health insurance or emergency medical expenses claim.
The policyholder had presented the local insurance office or the international insurance company with a claim. The claimant alleged that he/she was sick and was hospitalized for 14 days owing to any combination of three illnesses, noting the fact that they are three is a red flag. You should choose the conditions that are prevalent in your region. They are as follows:
- Malaria
- Cerebral malaria
- Typhoid
- Enteric fever
- Gastroenteritis
- Salmonellosis
- Pneumonia
- Cerebrospinal meningitis
- Hepatitis
- Pyelonephritis
- Tetanus
- Intestinal amebiasis
- Cancer
- Glaucoma
- Cataract condition
- Hypertension
- Gonorrhea
- Cholera
- Dengue fever
- Ebola Virus Disease
- Covid-19
- Lassa fever
- Measles
- Diabetes
- Post-Traumatic Stress Disorder (PTSD)
OR
He/She was hospitalized for injuries he/she sustained in a motor vehicle accident and surgically operated after staying for three (3) days in the Intensive Care Unit (ICU).
Thereafter, the policyholder presented the insurer with the claim documents as follows:
i. Medical Report
ii. Surgeon’s notes / Operative notes
iii. Physicians’ clinical orders and prescription notes
iv. Itemized Bill or Invoice for charges totaling the local currency equivalent of USD13,000.00. It indicates charges that include the use of the following:
a. Magnetic Resonance Imaging (MRI)
b. Computed Tomograph Scanning (CT scan)
c. Feeding
d. Electrocardiogram (ECG)
e. Laboratory
f. Endoscope examination
g. Operating Room
h. Physicians’ Fee
i. Nurses’ Fee
v. Laboratory Tests’ Result
vi. X-Ray report of the Radiologist
vii. Ultrasound scan examination report
viii. Physical therapist (Physiotherapist’s) notes
Four vital documentary proofs following the alleged treatment were omitted by this policyholder in presenting the claim. You should list them in drafting your report. That is whether you choose to write on the alleged treatment for three non-injury illnesses or for alleged injuries.
a) You are expected to write the letters for the hospital properly addressed, the independent radiological center, independent laboratory center, etc.
Also, write the note of instruction if the investigation is going to be conducted in a foreign country.
b) Next, you or the local Investigator in the foreign country attended the clinic or hospital. State the findings, noting that the radiology center presented an X-Ray examination report that did not mention the name of the physician that ordered the examination. What did you find out at the hospital?
If the management of the hospital cooperated, what documents or records were presented to you? What fraud did you note with respect to the manner the policyholder’s name was entered in the manual patients’ register, the clinical orders and prescription notes, the nurses’ observation notes, etc. You should state at least:
- one of the eight (8) indicators of fraud in the manual patients’ register,
- one indicator of fraud in the manual physician’s orders, and
- One indicator of fraud in the manual nurses’ observation notes.
Discuss if you had the need to engage a Medical Consultant and why it was necessary for you to do so. If applicable, discuss the salient aspects of the Consultant’s findings.
c) Write your report stating the investigative result and the findings at the hospital, the independent radiological center, laboratory, noting the indicators in them that the alleged hospitalization might have been contrived and thus a fraudulent claim. Your report must capture the pertinent appendices.
The characteristics of the report must be:
- Font or text size: 14
- Line spacing: 1.5
D. Presentation of the Report and Appendices
The candidates are expected to send their reports together with the appendices and attachments mentioned in the report via PDF to the-mail: info@insuranceantifraudprofessionals.com.
Please, attach a covering note to the report that will state the following:
a. your full name and complete address including your country
b. candidate’s registration number, and
c. e-mail address.
Assessment of the Report
The candidate’s work would be marked as per the following:
- How comprehensive it shows the proficiency in the technical skills required in ferreting fraud from the claim documents. 40%
- The candidate’s clarity and presentation such as the avoidance of spelling errors. This would be a gain of 30%. For each error in spellings, calculation, a percentage deduction is made from this score. If there are miscalculations and day/date mistakes such as a wrong day for a stated date, then a percentage is deducted accordingly.
If there are thirty (30) errors, then the candidate would see a deduction of the 100% score by 30%. If there is no single spelling error, arithmetic miscalculation, date or day mistake, gender mistake such as in stating his instead of her, then the candidate would gain the entire 30%. Arithmetic miscalculation is when the total of the figures is wrong. Day or date mistake is when the day does not correspond with the date, a quite common error with Investigators.
- Example: Tuesday, March 29, 2021 (This is an error because the correct day is Monday). If this was the only error, the candidate earns 29% instead of 30%.
- There is a 20% score for grammar. A general presentation of the report in good grammar earns the candidate additional 20%.
Opinion
The candidates are expected to present the facts of their simulated inquiries and investigations in the reports and no more. If any opinion is expressed, it will attract a deduction of a percentage.
Advisory
The candidates can seek for clarification on any gray areas of the subjects or materials by sending a PDF of the matter or their question to: Advisory Team: E-mail: info@insuranceantifraudprofessionals.com Our reply would be via PDF to your e-mail address.
Fee:
The total fee for the training is USD1800.00 (this excludes membership fees, + (USD175.00 for Adjunct and Full members or USD150.00 for student members)). This translates to a total of USD1950.00 for the student member and USD1975.00 for the adjunct and full members.
The fee covers the five (5) published texts/books + professor’s time to review your reports/tests, mark the papers, make corrections, and return the scripts to the candidate.
Study 5 books + Pass 1 Exam/Test = Earn 2 Certificates = Global career!
Note: The Examination/Test is also contained in the Associate Certificate + CIIP Program textbook.
Good luck to all the candidates. Register (click).
Study 5 books + Pass 1 Exam / Test = Earn 2 Certificates = Global career!
©2023 Global Insurance Anti-Fraud Professionals.
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