Claims Investigation & Fraud Detection: Evidence-Based Loss Prevention

About the Course

This comprehensive training program equips claims professionals, investigators, and risk managers with practical tools and proven methodologies for detecting, investigating, and preventing fraud. Participants learn evidence-based decision-making frameworks that reduce claim costs while maintaining ethical and legal compliance standards.

Through interactive case studies and real-world scenarios, learners develop proficiency in investigative techniques, digital forensics fundamentals, interviewing strategies, and fraud indicator recognition across insurance claims, worker's compensation, and general liability contexts.

Course Objectives

• Apply systematic investigative methodologies to claims evaluation and fraud detection
• Recognize fraud indicators and red flags across multiple claim types
• Conduct ethical interviews and gather admissible evidence
• Utilize digital forensics tools and data analysis for investigation support
• Document findings professionally and make defensible claim decisions
• Maintain compliance with legal and regulatory investigation requirements
• Develop critical thinking skills for evidence evaluation and analysis

Target Audience

This course benefits claims adjusters, investigators, fraud examiners, risk managers, and claims managers in insurance, healthcare, workers' compensation, and related industries. Professionals seeking to enhance investigation capabilities, advance into specialized roles, or strengthen organizational fraud prevention programs will gain immediately applicable expertise.

What You Will Benefit as a Learner

• Practical investigation frameworks you can implement immediately in daily claim evaluation
• Recognition of fraud patterns and indicators specific to your claims environment
• Professional interviewing and evidence-gathering techniques that withstand legal scrutiny
• Confidence in making defensible decisions backed by systematic analysis
• Enhanced ability to protect organizational profitability through effective loss prevention
• Understanding of digital evidence, social media investigation, and data analytics applications

Training Methodology

This course combines interactive lectures, hands-on case studies, small-group workshops, and simulation exercises. Participants engage with real claim scenarios, practice interviewing techniques, analyze evidence documentation, and develop investigation plans. Role-play activities build practical skills while group discussions promote knowledge sharing and problem-solving across different claims environments.