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Efficiency

What insurers can learn from government fraud investigators about public records searching

Whether investigating a personal injury claim or Medicare application, insurance and government investigators share common goals: minimizing fraud and protecting assets. A recent survey of government fraud investigators, who are also Thomson Reuters customers, revealed three best practices that can benefit insurance investigators.

1. Protecting your personnel

According to a Government Investigations Director, “When an agent approaches a suspect in the field, we need to have as many details as possible about what’s going on in their household. We look to see if they have a court record, a criminal history, bankruptcy, DWI, or have moved a lot. This gives us an idea of what’s going on and what their frame of mind may be.”

For insurance investigators, preventing fraud and prosecuting fraudulent claims not only increases company profitability, it also reduces premium costs for clients. But when investigators are interviewing claimants with violent or criminal histories, having a complete view of their background is crucial to minimize physical risk to the investigator. Comprehensive public records searches, using tools similar to government investigators, can better prepare investigators for a given situation.

2. Locating witnesses without compromising relationships with your customers

An IT Specialist in the government says, “We had a huge project where we were going to go to trial, and we needed to find 20 employees that would be willing to testify for a very important case. Generally, we would send out investigators to knock on doors to try and find these people. It is common for people working in agriculture or low wage industries to move a lot, which makes it difficult to locate them by going door to door. But, by using public records, we were able to locate witnesses, which led to prosecuting our case against this individual.”

Identifying witnesses for potential insurance fraud can be a difficult and sensitive situation. Investigators aim to retain client loyalty and brand reputation by avoiding lengthy investigations. Not only can the use of public records uncover historical data that may point to fraudulent activity, it does so without involving the client and potentially damaging the company’s relationship with a customer who has a valid insurance claim.

3. Leverage the right tools

“Tactically, we want to avoid investigative dead ends that prevent us from accomplishing our goal,” says a Government IT Specialist. “We had a case that would have been closed because we didn’t have enough information to work with. We work on facts. If we don’t have any facts, then we know we can’t ask for back wages for these employees. By leveraging our public records searches, we filled in previously unknown information and avoided hitting a dead end.”

By leveraging public records search tools, investigations can be streamlined, danger to investigators can be diminished, and agents can be more efficient at preventing fraudulent claims.

For both government and insurance investigators, building efficiencies against fraudulent activities leads to prosecuting scam artists, increased customer satisfaction, and recuperated funds. Over the long run, these strategies can also serve as a deterrent to potential fraud.

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