generali asigurari frauda si caracteristicile autohtone fiar 2010
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Generali Asigurari Frauda si caracteristicile autohtone FIAR 2010. AGENDA. Clasificare fraude. De obicei implicati si in alte infractiuni. Barbat. Tanar < 30 ani. Casatorit. Necasatorit. Angajat. Grupare criminala. Detinator credit. Somer / angajat part time. Raportare client la UW. - PowerPoint PPT PresentationTRANSCRIPT
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GeneraliGenerali Asigurari Asigurari
Frauda si caracteristicile autohtoneFrauda si caracteristicile autohtone
FIAR 2010FIAR 2010
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AGENDA
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BarbatCasatorit
AngajatDetinator credit
Tanar < 30 ani
Somer /angajat part time
Necasatorit
Grupare criminala
De obicei implicati si in alte infractiuni
Clasificare fraude
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Raportare client la UW
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Identificarea simptomelor unei fraude
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• Sistemul de alertare ar verifica automat parametrii.
• Definirea unui nivel de de risc aferent fraudelor si generare alerte in sistemul de gestiune daune.
• Un potential mare ca sursa de informatii
• In prezent este imposibil de combinat sursele externe cu sursele interne. Unele din sursele externe fiind accesibile doar prin varianta clasica : adresa scrisa.
Baze de date pe care putem/ ar trebui sa le accesam
Politie (identificare persoane, placute inmatriculare etc)
Alte autoritati (Pompieri,Ambulanta etc)
CSA - Cedam
EX
TE
RN
INT
ER
N Sistem de gestiune daune
Sistem gestiune polite
Sistem alertare
Sistem de gestiune
daune
ANAF (Min de Finante) (cazuri de faliment, cazier fiscal)
UNSAR
Baza de date cu daune la nivel national
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Punerea accentului pe dezvoltarea instrumentelor IT de detectare a fraudelor sau a indicilor ce pot anunta o frauda sunt de preferat in locul depistarii manuale lasate in seama inspectorilor de dauna.
Cei ce produc fraude au un ritm de dezvoltare mult mai rapid decat societatile de asigurare,de accea uneltele IT sunt de o necesitate acuta.
Rolul IT in daune
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Rolul IT in daune
Existenta celor 3 sisteme in Romania, Audatex, Eurotax si DAT isi aduce pe deplin aportul in stabilizarea modului de colaborare intre reparatori si asiguratori.
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Cazuri frecvente
Cateodata reusim sa ne convingem asiguratii/ pagubitii ca porcii nu zboara
Actiuni necesare dupa respingerea unui dosar:* plangere penala* raportarea cazului catre subscriere * rezilierea politei daca e casco* publicarea exemplului in presa
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Organizatii internationale
IAIFA – International Association of Insurance Fraud Agencies
IFB – Insurance Fraud Bureau – UK
IFIG – Insurance fraud investigators group – UK
NICB – National Insurance Crime Bureau- USA
CBV – Centrum Bestrijding Verzekeringsfraude – NL
ACFE – Association of certified fraud examinators – USA
EHFCN – (European Healthcare & Corruption network)
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Masuri preventive
CFR
Descriere Ce vizeaza Impact
Identificarea erorilor in cadrul procesului de lichidare a daunelor si remedierea lor prin modificare proceduri/ procese
Closed file review
OFR
Training in vanzari
Open File Review
Diminuarea “scurgerilor” ocazionate de lichidarea superficiala a dosarelor
Identificarea rapida a fraudelor, si remedierea pe loc a erorilor
Identificarea clientilor corecti subscriere eficienta.
Identificarea potentialelor erori chiar in cadrul procesului de instrumentare a dosarului
Pregatirea fortei de vanzare pentru subscriere corecta, si moduri de evitare a potentialilor fraudatori
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Gaseste diferentele
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Auto prezentat la inspectie
Auto avariat
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• Benjamin Franklin: “A penny saved is a penny earned.”
Source: http://www.quotedb.com/quotes/977, Despagubiri : Cost Operational = 9 : 1 !
Despagubiri
Costuri
operationale
Costuri de achizitie,
admin, etc
Prime
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Madalin RosuHead of ClaimsGenerali RomaniaPhone: +4 0740 109 325Email: [email protected]