PROCESS & ORGANISATION
Detection will not be successful without a good follow-up. The organisation of the process and the governance are crucial.
Dealing with fraud is 80% prevention and no more than 20% repression or ‘catching the crooks’. The best prevention is to stop potential fraudsters at the ‘front door’, that is at underwriting. The fraud management policy of individual companies is, therefore, primarily aimed at this. Prevention of fraud begins with the sensitivity to fraud of the products themselves and therefore attention must be paid to this at the start during product development. Another important point for attention in the aspect of processes and organisation is the position of the fraud coordinator. Our experiences in this area are very varied. The position of the fraud coordinator in the organisation is very often seen to be unclear. What are the tasks, authorities and responsibilities of the person holding this function? And how much room is he given? In still too few organisations is this a person with authority, by reason of the position and knowledge of affairs, who is fully backed by his board, and due to the continual increase in scale of the insurers the fraud coordinator is coming to be increasingly further removed from the work floor. In our view the fraud coordinator must have access to the correct instruments to carry out and check the fraud policy that has been established, a direct line of communication with the board and be represented in or close to the departments in the form of fraud contact persons. This also requires the board to be open to such a structure and ready to devote attention and energy to this. The process of dealing with potential fraud cases must also be uniform and embedded in the organisation. Dealing with signals that point to possible fraud in times of straight through processing is increasingly becoming part of the primary process. Therefore, support and management of this process are increasingly important. As well as this, employees must remind each other of their responsibilities. A comment made by an employee such as: “I never hear anything back from my reports of fraud” is disastrous for future reports. This is one of the greatest traps for an effective system of detection and repression of fraud. Friss provides support in setting up and linking the existing processes of the fraud management process (detection, prevention, handling, repression). We provide advisors specifically for this who can guide your organisation through the implementation of the necessary changes (processes, activities, roles, responsibilities etc.). We use the reference models that we have developed for setting up processes for implementing fraud management for this.