Case Study Of Counter Fraud In The Insurance Company

The customer service personnel should be in a position to acknowledge their clients and pay attention well to whatever they say and put into practice active listening. They should also give a chance to the customers to respond to the services the company offers perhaps through the enterprise’s website. For any company to prosper, good customer relation is paramount in building a loyal

The company knows the demands of the customers and they are well orientated in the service and the knowledge of the products and this is the element that makes them prosperous. Jean’s Rare Find Books belief in customer service and satisfaction enables a comfortable and peaceful atmosphere and in return produces a strong customer loyalty for the company. Customer satisfaction and customer retention externally and internally is measured by the perspective of the customers and thus implements the reason for the company’s prosperity. Customer perspective is a key factor on how the customer views the company.

Perhaps the finest total dollar quantity of fraud is devoted via the medical health insurance companies themselves. There are severa research and articles detailing examples of insurance companies deliberately not paying claims and deleting them from their structures,[21] denying and cancelling coverage, and the blatant underpayment to hospitals and physicians beneath what are normal costs for care they provide.[22] Although tough to acquire the records, this fraud via coverage agencies may be anticipated through comparing revenues from premium bills and prices on health

The amount listed is the enrollment agreement was 10,020.00 which gives a difference of :

business of insurance. But the lack of uniformity, loop holes, blind spots and deficiencies within

New Jersey Oncologist, Practice and Practice Manager Pay $1.7 Million to Resolve FCA Allegations Involving Billing for Illegally Imported Chemotherapy Drugs

Deutsche Allgemeinversicherung (DAV) is one of the world’s largest insurance companies. The success of the company has been contributed to its product offerings and “an excellent group of insurance managers” (case page 2). The company provides superior “traditional insurance management” and excellent customer service. However, the company began to face stiff competition not only from larger competitors but also from smaller insurance firms that are able to provide customized service to each individual client. To keep its current position in the market DAV has decided to concentrate on quality of customer service which it sees as a core competency. The

We should focus on treatment, not punishment… OIG report suggests prescribers are not checking the databases, or databases lack current data. What’s their training?

This paper will discuss in some detail about what goes into a good salesperson and how to get clients. It will also discuss six total rewards program. Define the behaviors of the sales force that are targeted with the compensation plan. Next, look into how a value proposition is accomplished for current and future employees at car lot. Specify how fascinated future salespeople may be in the near future.

Healthcare fraud is costly for everybody, as it harms the reputation of the institution or physician committing it, and financially damages the patient being affected.By definition fraud may be defined as intentionally employing surprise, trickery, cunning, deception and unfair ways by which one party cheats another party out of financial resources. In order to educate a healthcare manager regarding fraud , many aspects of fraud must be assessed. This includes the types of fraud, the consequences that come with fraud,the individual(s) committing them, techniques to prevent fraud, and why the healthcare industry is vulnerable to fraud.

Frequently the media depicts insurance fraud to be most commonly committed by individuals who invest in the insurance firms for promising protection and

The previous organizational structure for payment of services rendered did not allow officials enough time to investigate claims to ensure the claims were legitimate. Perpetrators study the law and use the knowledge to fraud insurance and government agencies. The governance of rules, regulations and laws was not stringent enough to stop perpetrators from frauding the system. New guidelines allow agencies more time to detect suspicious claims, investigate and save the insurance companies millions of dollars. Society does not concentrate on proactive actions to prevent fraud, instead society deals with the problem after the fact. Consumer watch groups do not have tools in place to prevent fraud. Perpetrators rely on the oversites of insurance companies in order to target and fraud insurance companies.

Changes in tax laws, government benefit programs, and other State and Federal regulations can affect the insurance needs of clients and how agents conduct business (Abraham & Herman, 1998). Courses in psychology, sociology, and public speaking can prove useful in improving sales techniques (Abraham & Herman, 1998). The use of computers to provide instantaneous information on a wide variety of financial products has greatly improved agents’ and brokers’ efficiency and enabled them to devote more time to clients’ needs (Abraham & Herman, 1998).

A business can not work out without an account system, which includes internal. Internal controls are used by companies to make sure financial information is accurate and valid. Strong internal controls are signs of a financially healthy company and protect the company’s integrity. Strong internal controls can also increase a company’s profitability. There are several types of internal controls that companies used to protect themselves such as: Segregation of duties, asset purchases, supervisor review, internal audits and adequate documents and records. This paper will discuss several topics from a case study about And the Fraud

IT plays a role in servicing a large number of clients and reduce processing cost. At the same time IT can help in churning out statistics and information necessary to analyse the performance of current and potential business. As such, Sun Life need to look into the aspect of insurance systems and IT infrastructure in Malaysia.