Identification and Development of Employee Competencies in Managing Insurance Fraud

Transcription

1 Identification and Development of Employee Competencies in Managing Insurance Fraud Admiral on Demand Whitepaper Document protection 2014 Optilab d.o.o. Author: Nuša Anna Hrustek, mag. All rights reserved. Reproduction by parts or in whole in any way and in any media is prohibited without written consent of the author. Violations are sanctioned according to international laws against copyright violations and trademark infringement. Document author & owner: Optilab d.o.o.

2 Introduction Fraud and scams affect every field, and they are growing with every year that passes. On the other hand, theft and other property crimes aren t following the same growing trend. How can this be, and why are more and more people tempted to commit insurance or commerce fraud? Research shows that our sense of our own morality is connected to the amount of cheating we feel comfortable with. Essentially, we cheat up to the level that allows us to retain our self-image as reasonably honest individuals. Research also shows that the average person is much more likely to steal something that doesn t explicitly reference monetary value. The more cashless our society becomes, the more difficult it is to maintain our moral compass in daily decision making (Ariely, 2013). This is why downloading music and movies isn t perceived as theft by most, and why otherwise honest people, who would never steal or shoplift, find it much easier to bend the truth on a vehicle accident report or exaggerate their pains in a health insurance claim. Increasingly, fraud and scams occur in health care with regard to health insurance, in banking with regard to credit card use, in e- commerce, but also in the form of tax evasion, and in other business processes. Efficient fraud management usually requires reorganization of the work process and of the execution of work tasks, measuring of the set goals, while day-to-day processes also require interaction with potentials fraudsters. As claims are more and more complex, and outright fraud is smarter every day, insurance companies face ever increasing pressure to improve their fraud management. In order to consistently manage the negative impact of fraud on the bottom line, fraud prevention technology must be accompanied by adequately trained staff. Key staff Insurance fraud takes the form of many complex and innovative approaches, and fraudsters regularly come up with new strategies to avoid detection. This is why insurance companies must take a proactive approach to solving this issue. Within insurance companies, fraud management is handled by independent offices organized by the insurance company, departments for claims settlement and other retained qualified professionals (former detectives, police officers etc.). Occasionally, insurance companies will hire external investigators such as private detectives and security professionals to operate in the field. Key staff in charge of settling insurance cases involves investigators, appraisers, damage analysts, external investigators and the legal department. Figure 1 depicts the process of settling insurance claims and the key staff involved in such a process. Page 2

3 Figure 1: Key staff involved in the process of settling insurance claims (R means repayment) Occupational competencies Employers need and seek out competent employees who are able to efficiently solve, even in volatile situations, tasks geared at efficient fraud management. With regard to the specific technologies and the arising work tasks, they are expected to meet several specific competencies. The work environment represents an important teaching environment where individuals can develop their competencies through direct experience (Gorše, 2013). Formal education makes up for only a portion of the information necessary to assess the prospective individual to be either selected or trained. Competencies are deemed to be behavior which takes time to develop, and which has to be monitored at one s respective work place (Gorše, 2013). During an interview or glancing at the respective job applicant s CV, competencies are not as straight-forward and prominent as formal education, however they are equally important as they provide a clearer picture of the numerous abilities of the employee, which had been acquired at the relevant work place (Gorše, 2013). Page 3

4 Development of employee competencies In addition to knowledge and abilities, the development of employees also promotes their commitment to the company, deepens trust between employees and to the company management, boosts confidence and self-confidence, as well as employees sense that they are appreciated at the company, and mainly their dedication for reaching common company goals (Andrejc, 2010). Insurance companies should implement a program aimed at developing employee competencies, which would include: personal development, professional development and occupational development. Through various types of development, all three elements are being intertwined and promoted. Ensuring adequate competencies of employees may be carried out in stages, i.e. through various seminars aimed at acquiring knowledge by employees and reaching a higher level of education in accordance with programmes of verified educational institutions (Andrejc, 2010). Employee development is very important as it represents a competitive edge for the company, but also acts as strong motivation for the employees. Seminars and trainings must not be too comprehensive, irrelevant and inadequate, because this may affect staff development in an adverse manner (Rozman, Kovač, Koletnik, 1993). Specific functional know-how relating to the organization s respective field and other additional professional knowledge from employee s respective field is gained in the framework of courses and trainings at in-house or external seminars, courses and workshops. Here, they also acquire skills necessary to manage changes at their work place, acquire knowledge with regard to using state-of-the-art technology, and acquire soft skills to manage people etc. (Andrejc, 2010). Practical experience acquired in the course of work promotes their skills, enhances independence, helps to get an insight into the organization s operations etc. Of course it is also necessary that employees engage in autonomous learning, being that self-learning can enrich their knowledge and expand their professional horizons, thereby altering their values, mentality and habits (Andrejc, 2010). Identifying competencies Employees in the insurance industry are under constant pressure by the management, public, media and also politics; there is no room for error. They are faced with unpredictable situations and people along the way, and they must have the skill set to react correspondingly. Page 4

5 In an insurance company, the processing of a damage event where fraud is suspected, can include external investigators and experts with different competencies and prior know-how on the topic, in addition to in-house investigators. Based on direct business process observation within the insurance company, and based on an analysis of written sources, we believe that the competencies set out in the following six fields are required to successfully reach the set goals. Figure 2: Job-specific competencies Insurance company management must realize that individuals who have only just started out in this profession cannot be expected to generate the same output as their more experienced colleagues. On the other hand, employees are expected to possess the suitable education and the basis to improve their competencies over time. Employees involved in handling insurance cases must possess specific competencies in order to improve the company s performance of insurance fraud management but they also need know-how and experience. This is what sets apart a successful employee engaged in handling insurance cases. Page 5

6 Conclusion We observe that in identifying and leveraging competencies and staff development there is often not enough emphasis on the staff itself, even though staff is vital for the existence, success, and progress of any organization. Insurance company management teams tend to neglect staff competencies and their development, and underinvest in staff and the identification of their competencies. Without investments in the development of human resources, i.e. without providing for additional education and training, insurance companies cannot efficiently manage their core operations. Recently, insurance companies have been more forthcoming in this area, providing in-house seminars and training for their staff, as well as supporting their attendance at various external educational events. Based on this, we can conclude that insurance companies are, at least in theory, aware of the significance of ongoing and continuous staff development, and are acting to improve their position. But since this isn t enough, it is also necessary that managers in insurance companies realize the issue of competencies and staff development, and start focusing on it more. They should implement measures, which will allow for greater focus on their staff. At the same time, it is necessary to identify those competencies that are lacking in employees, and determine in practice the actual needs for specific types of knowledge. Lastly, we would like to point out that in order to improve their performance with regard to managing insurance fraud in car insurance, insurance companies would have to allot a portion of their funds for the education and training of key staff, as well as for the development of their personal competencies, which are a prerequisite for performing their job. Page 6

7 References The paper is based on: Hrustek, Nuša A. IDENTIFICATION AND DEVELOPMENT OF EMPLOYEE COMPETENCIES IN MANAGING INSURANCE FRAUD. Cyber Times International Journal of Technology & Management. Vol. 7, Issue 2, pp , April 2014 September References: Andrejc, A. (2010). Razvoj zaposlenih z uporabo sodobnih kadrovskih orodij (Zaključna projektna naloga). Koper: Fakulteta za management. Ariely, D. (2013). Honest Truth About Dishonesty: How We Lie to Everyone--Especially Ourselves. Harper Perennial Gorše, M. (2013). Kompetence kriminalističnega preiskovalca (Diplomsko delo). Ljubljana: Fakulteta za varnostne vede. Rozman, R., Kovač, J. in Koletnik, F. (1993). Management. Ljubljana: Gospodarski vestnik. We protect insurance companies from fraud info@optilab.net t: Optilab Headquarters Optilab d.o.o. Dunajska cesta Ljubljana Slovenia Optilab Ajdovščina Optilab d.o.o. Župančičeva Ajdovščina Slovenia Page 7