Investigation Solutions

Claims fraud analysis involves our investigation solutions team systematically reviewing and analyzing suspect claims to detect potential fraud. Using data analytics, machine learning, and anomaly detection, our internal Special Investigations Unit (SIU) investigators can uncover suspicious patterns, such as inflated claims or false reports. This process is essential in helping insurers identify fraudulent claims while regularly analyzing claims before payments are made, protecting the company’s profitability and reducing fraud-related costs.

Our traditional and remote surveillance services are designed to provide thorough and unobtrusive monitoring of subjects in various settings. Whether it’s on-site surveillance or remote observation, our experienced investigators capture essential video and photographic evidence to support informed decisions. Each assignment is tailored to your specific needs, ensuring that actionable information is obtained for your case. We uphold a high standard of professionalism and confidentiality, delivering comprehensive reports that are valuable for insurance claims, legal matters, or internal investigations.

Medical canvassing uncovers relevant medical histories by systematically researching local healthcare providers and facilities. Our SIU team discreetly gathers information on any prior treatments, consultations, or prescriptions that may relate to an individual’s claim. This service helps reveal undisclosed injuries or treatments, enabling our clients to make well-informed decisions in cases of potential insurance fraud or other investigations.

In today’s digital age approximately 60% of the world’s population has a social media presence. It is imperative that effective social media investigations are conducted for gathering public, real-time insights into subjects’ lifestyles, connections, and activities. Our investigators comb through accessible online platforms to uncover key information that can support claims, legal cases, or pre-employment screenings. By analyzing social media footprints, we provide clients with additional layers of context, exposing details that may not be apparent in traditional records.

Our background investigations provide an in-depth look into an individual’s history, encompassing criminal records, employment verification, financial history, and more. We aim to uncover relevant information that aids in hiring decisions, insurance claims, or personal investigations. With a meticulous approach, our background checks offer a comprehensive view, empowering clients to proceed with confidence and clarity.

SIUs must often report suspected fraudulent activities to the Department of Insurance (DOI) and state attorneys for further investigation or legal action. When our investigative experts file formal reports, this may also trigger investigations by regulatory authorities or law enforcement officials who aid in bringing the fraudsters to justice.

Periodic file reviews across all lines of insurance involve SIU experts thoroughly examining claim documents, such as medical records, financial documents, and other related files, for “red flag” indicators of fraud or discrepancies. 

Investigation Solutions is responsible for conducting fraud training across all lines of business to help adjusters, underwriters, and other insurance professionals understand how to recognize common signs of fraud, how to investigate, and where to report suspicious activities. Training is often state-mandated and can be provided in whatever fashion best suits the business and complies with state regulations, whether in-person or online.