INTERNATIONAL CLAIMS INVESTIGATION
ICI Q1 2019 REFERRALS
WHAT HAVE WE FOUND?
Two Peruvian claims were flagged as suspicious to ICI, and investigations led to us finding out the members were in fact fake aliases, using fake invoices (from real providers) as well as generating fake airline documentation showing proof or travel.
Utilisation of a Peruvian national on the CS floor really helped us stopping the payments, saving us over £12,000
Did you know....
ICI triage 88% of referrals back to the business.
We take extreme care in assigning case for investigation, ensuring we're only intervening in cases we really need to be involved with.
Our fraud conversation rate of the cases we take on is 81%, showing the importance of this triage in detecting fraudulent activity
A Greek couple joined from a rival insurer, declaring they had no previous medical conditions.
An early claim for a chronic condition led us to working with the other insurer to discover a large previous history of several very serious conditions, preventing fraudulent claims being paid for over £153,000
FRAUD OUTCOMES - by business type
FOLLOWING A SLIP UP FROM A MEMBER, WHO SENT US THE INVOICE INTENDED FOR THEIR OTHER INSURER, WE FOUND THAT THEY HAD BEEN DOUBLE CLAIMING FOR MANY TREATMENTS, WHILST WORKING IN MALAYSIA.
THE MEMBER (ON A CORPORATE GROUP) REPAID US £12,865 THAT HAD BEEN OBTAINED FRAUDULENTLY
THE AXA GULF TEAM REFERRED A CASE TO ICI FOR HIGH VALUE TREATMENTS IN INDIA. FOLLOWING INVESTIGATION, IT WAS FOUND THIS CORPORATE MEMBER HAD BEEN CREATING FAKE INVOICES FOR TREATMENTS FOR HIM AND HIS FAMILY.
PREVENTION OF THOSE INVOICES SAVED US £3,800