Agenda

    • Sunday, March 10, 2019
    •  
      1:00 PM  -  5:00 PM
      Exhibitor Registration
      3:00 PM  -  5:00 PM
      Attendee and Speaker Registration
      6:00 PM  -  8:00 PM
      Welcome Reception
    • Monday, March 11, 2019
    •  
      7:00 AM  -  5:00 PM
      Registration
      7:00 AM  -  8:00 AM
      Continental Breakfast
      8:00 AM  -  8:20 AM
      Welcome
      Automation technology promises a new world of claims processing—and those innovations are set to provide substantive improvements to fraud detection as well. One important change will be the shift from rules-based fraud discovery to predictive modeling. As new data sources are tapped to build the fraud picture, powerful data processing from technologies such as cloud computing will help us uncover suspicious behavior faster and better. The ISO ClaimSearch transformation to a visualized platform is foundational in this effort. The new platform provides faster, deeper insights to the SIU team including automated alerts based on key indicators of potential fraud.
      Speakers:
      Hosts:
      8:20 AM  -  8:55 AM
      NICB: State of Insurance Fraud in America
      Joseph H. Wehrle, Jr., president and CEO of the National Insurance Crime Bureau, will address the conference with an update on his organization’s operations and the general state of insurance fraud in America, in addition to sharing his vision of the future of fraud fighting. This executive-level presentation will highlight the evolution of the anti-fraud function and the unique positioning and effectiveness of the NICB. He will also touch on some of the latest trending schemes and the implementation of technology used to help resist and prosecute insurance fraud.
      Speakers:
      8:55 AM  -  9:30 AM
      Keynote Address: Keeping Pace
      The insurance industry is evolving all around us. Specifically, customers are expecting more: more options that are simple, fast, and completed with quality and accuracy. The world of insurance fraud is no different, and companies must be equipped with the best tools, data, and people available to prevent fraud wherever possible. On March 11, we’ll explore the ever-changing dynamics around the insurance industry, insurance fraud, and how businesses like State Farm® and others can remain agile enough to keep pace with fraudsters of all types.
      Keynote Speaker:
      9:30 AM  -  10:50 AM
      101. Social Media: The Latest Investigative Insights and Management Concerns
      Social media continues to grow and evolve across the investigative landscape with many new issues and concerns that continue to crop up around the SIU community. In what has become an annual update, this session will delve into the latest in search engines, footprints and audit trails, ethical considerations, usage policies, e-commerce expansion, manipulated digital images, chain of custody, and privacy concerns. This is sure to be a lively session with a chance to share your experiences.
      9:30 AM  -  10:50 AM
      102. Auto Application Misrepresentation and the Potential of Collateral Damage
      Automobile application misrepresentation is a major issue that can lead to additional costs and collateral damage from those falsifications at the time of a claim. In this follow-up session from 2018, the discussion will center on the strategies and workflows related to the use of technology to assist in detection at the point of sale and then later at the point of claim and beyond. The attempt to mislead at policy inception can be the tip-off to the claims that can follow. Participate in this discussion as the presenters talk about uncovering patterns and altering both application and claim-making behavior.
      Speakers:
      9:30 AM  -  10:50 AM
      103. Audit and Compliance Panel Discussion
      This panel session is a continuing discussion covering the significant concerns of SIU management around regulatory audits and compliance issues, with a glimpse into what may be developing in the near future. Expert panelists will talk through the issues of fair claim practices, targeted training programs, fraud plan construction and maintenance, market conduct exam preparation, regulation variances and emerging interpretations, the development of regulator relationships, and mandatory reporting. These issues are core to the successful management of an anti-fraud function. This interactive discussion will include attendee commentary, so bring your questions, suggestions, and be a participant.
      Moderators:
      9:30 AM  -  10:50 AM
      104. Managing the Anti-Fraud Training Process
      The world of insurance fraud is certainly a fluid environment. This session will explore the myriad related issues that include the latest training technologies, learning methods, late-breaking fraud trends, regulatory requirements, and training program management techniques. Speakers will also address what is happening with NICTA, the NICB Training Academy, and other resources. The discussion will also touch on underwriting issues, call centers, producers, law enforcements needs, and public awareness. Attend this session to get up to speed on the latest in setting up and maintaining your anti-fraud training program.
      Speakers:
      10:50 AM  -  11:20 AM
      Refreshment Break
      11:20 AM  -  12:40 PM
      201. Social Media: The Latest Investigative Insights and Management Concerns
      Social media continues to grow and evolve across the investigative landscape with many new issues and concerns that continue to crop up around the SIU community. In what has become an annual update, this session will delve into the latest in search engines, footprints and audit trails, ethical considerations, usage policies, e-commerce expansion, manipulated digital images, chain of custody, and privacy concerns. This is sure to be a lively session with a chance to share your experiences.
      11:20 AM  -  12:40 PM
      202. Auto Application Misrepresentation and the Potential of Collateral Damage
      Automobile application misrepresentation is a major issue that can lead to additional costs and collateral damage from those falsifications at the time of a claim. In this follow-up session from 2018, the discussion will center on the strategies and workflows related to the use of technology to assist in detection at the point of sale and then later at the point of claim and beyond. The attempt to mislead at policy inception can be the tip-off to the claims that can follow. Participate in this discussion as the presenters talk about uncovering patterns and altering both application and claim-making behavior.
      Speakers:
      11:20 AM  -  12:40 PM
      203. Audit and Compliance Panel Discussion
      This panel session is a continuing discussion covering the significant concerns of SIU management around regulatory audits and compliance issues, with a glimpse into what may be developing in the near future. Expert panelists will talk through the issues of fair claim practices, targeted training programs, fraud plan construction and maintenance, market conduct exam preparation, regulation variances and emerging interpretations, the development of regulator relationships, and mandatory reporting. These issues are core to the successful management of an anti-fraud function. This interactive discussion will include attendee commentary, so bring your questions, suggestions, and be a participant.
      Moderators:
      11:20 AM  -  12:40 PM
      204. Managing the Anti-Fraud Training Process
      The world of insurance fraud is certainly a fluid environment. This session will explore the myriad related issues that include the latest training technologies, learning methods, late-breaking fraud trends, regulatory requirements, and training program management techniques. Speakers will also address what is happening with NICTA, the NICB Training Academy, and other resources. The discussion will also touch on underwriting issues, call centers, producers, law enforcements needs, and public awareness. Attend this session to get up to speed on the latest in setting up and maintaining your anti-fraud training program.
      Speakers:
      12:40 PM  -  1:40 PM
      Lunch
      1:40 PM  -  3:00 PM
      301. SIU Technology Modernization Projects: Critical Considerations and Learnings
      Carriers are continually challenged to optimize the claim-handling and settlement process. Several factors are driving the need for carriers to quickly innovate, including customer service expectations of policyholders, getting the right work to the right people, and expense pressures to find process efficiency and effectiveness. This end goal is ultimately straight-through processing of claim capabilities. However, this approach presents great challenges to SIU’s strategy and the need to move to a proactive model that can identify potentially suspicious claims for investigation. The growing executive investment in artificial intelligence and machine learning capabilities has gone from aspiration to ideation and is now a reality. SIU leaders should have a seat at the table to understand enterprise strategy and be part of the process to ensure critical opportunities are factored into the road map.
      1:40 PM  -  3:00 PM
      302. Managing Major Case Operations Panel Discussion: Strategies and Tactics
      Over the past several years, the SIU community has been investing more effort in the detection and resistance of large-scale insurance fraud conspiracies. These types of assignments involve the intricacies of strategy development, tactical planning, designed workflows, multilevel task assignments, third-party assistance, law enforcement interface, expert witnesses, and legal counsel. In addition, the scheduling, tracking, and reporting within this discipline can become extremely taxing. In this session, an expert panel will talk through the complexities of these issues and field questions and comments from attendees.
      Moderators:
      1:40 PM  -  3:00 PM
      303. Building and Enhancing Small to Midsized SIU Departments
      The general mission of the SIU function remains constant regardless of the size of the organization: assisting the adjusting and underwriting staffs in the resolution of their assignments. But beyond the mission, the nuances of smaller and mid-sized units are operational and structural realities that require some differing approaches. Certain differences in scale, reach, and resources affect tactical planning on carrying out departmental strategies. The speakers will discuss topics such as budget, specialization, third-party assistance, generation of influence at the LE level, access to technology, interdepartmental assistance and resources, and career pathing. Attend this session and discuss how these panelists manage through the challenges.
      1:40 PM  -  3:00 PM
      304. Managing and Utilizing the NICB and the ISO ClaimSearch Industry Data in Your Environment
      Understanding and fully utilizing the available industry data from NICB and ISO ClaimSearch are strategic keys to efficient investigative management. These sources of insight are the low-hanging fruit that can help lead to prompt and accurate claim resolution decisions. Participate in this expert-led session and discuss the latest in data set availability, best practices, new detection techniques, and more.
      3:00 PM  -  3:30 PM
      Refreshment Break
      3:30 PM  -  4:50 PM
      401. SIU Technology Modernization Projects: Critical Considerations and Learnings
      Carriers are continually challenged to optimize the claim-handling and settlement process. Several factors are driving the need for carriers to quickly innovate, including customer service expectations of policyholders, getting the right work to the right people, and expense pressures to find process efficiency and effectiveness. This end goal is ultimately straight-through processing of claim capabilities. However, this approach presents great challenges to SIU’s strategy and the need to move to a proactive model that can identify potentially suspicious claims for investigation. The growing executive investment in artificial intelligence and machine learning capabilities has gone from aspiration to ideation and is now a reality. SIU leaders should have a seat at the table to understand enterprise strategy and be part of the process to ensure critical opportunities are factored into the road map.
      3:30 PM  -  4:50 PM
      402. Managing Major Case Operations Panel Discussion: Strategies and Tactics
      Over the past several years, the SIU community has been investing more effort in the detection and resistance of large-scale insurance fraud conspiracies. These types of assignments involve the intricacies of strategy development, tactical planning, designed workflows, multilevel task assignments, third-party assistance, law enforcement interface, expert witnesses, and legal counsel. In addition, the scheduling, tracking, and reporting within this discipline can become extremely taxing. In this session, an expert panel will talk through the complexities of these issues and field questions and comments from attendees.
      Moderators:
      3:30 PM  -  4:50 PM
      403. Building and Enhancing Small to Midsized SIU Departments
      The general mission of the SIU function remains constant regardless of the size of the organization: assisting the adjusting and underwriting staffs in the resolution of their assignments. But beyond the mission, the nuances of smaller and mid-sized units are operational and structural realities that require some differing approaches. Certain differences in scale, reach, and resources affect tactical planning on carrying out departmental strategies. The speakers will discuss topics such as budget, specialization, third-party assistance, generation of influence at the LE level, access to technology, interdepartmental assistance and resources, and career pathing. Attend this session and discuss how these panelists manage through the challenges.
      3:30 PM  -  4:50 PM
      404. Managing and Utilizing NICB and ISO ClaimSearch Industry Data in Your Environment
      Understanding and fully utilizing the available industry data from NICB and ISO ClaimSearch are strategic keys to efficient investigative management. These sources of insight are the low-hanging fruit that can help lead to prompt and accurate claim resolution decisions. Participate in this expert-led session and discuss the latest in data set availability, best practices, new detection techniques, and more.
      5:00 PM  -  6:30 PM
      Wine & Cheese Reception
    • Tuesday, March 12, 2019
    •  
      7:30 AM  -  4:30 PM
      Registration
      7:30 AM  -  8:30 AM
      Continental Breakfast
      8:30 AM  -  9:50 AM
      Emerging Litigation Issues That May Have an Effect on SIU Management
      Prudent SIU management includes keeping a close eye on recent and emerging litigation affecting the anti-fraud community and how those issues can affect the SIU function. In this moderated session, a panel of nationally recognized attorneys will share their views on topics that include recent case law interpretation, defending against institutional attack, employment of new technologies, availability of new data sets, emerging statutes, and more. This is an important session that can assist in being better prepared for risk avoidance. Come prepared to participate.
      Moderators:
      9:50 AM  -  10:10 AM
      Refreshment Break
      10:10 AM  -  11:30 AM
      501. Life, Disability, and Long-term Care: Fraud Trend Panel Discussion
      SIU senior management from the life, disability, and long-term care space will conduct a moderated panel discussion covering some of the fraud trends and responses in those lines of business. Similar to the traditional property/casualty world, misrepresentation attacks to gain access to benefits are the driving factor in this category. The tactics include fraudulent medical and service provider billing, unreported wellness, unsubstantiated waiver claims, and more. Discussion points will include new tools and techniques, analytic advancements, data availability, institutional risk avoidance, regulatory compliance, and cross-border concerns. This is sure to be a lively and interactive session.
      Moderators:
      10:10 AM  -  11:30 AM
      502. SIU Management Issues Panel
      This moderated expert panel will focus on some pressing issues the SIU management community faces. Attend this session and be part of the discussion on topics that will include unit structure development, process reengineering, staffing skill sets and diversity, discipline specialization, outsourced assistance, and streamlining. The panelists will also touch on artificial intelligence, robotic processing, and other new-wave efficiency movements.
      Moderators:
      10:10 AM  -  11:30 AM
      503. Provider Fraud Detection and Resistance: Developing an SIU Management Mission and Strategy
      The concept of resisting medical provider misrepresentation and actually executing that endeavor aren’t the same. To successfully operationalize that task, ground-zero planning can lay a proper foundation to support the necessary tacks that follow. This session will be a high-level discussion covering mission statement development, strategies that fit a corporate environment, and tactics that can achieve goals while reducing risk. Speaking points will include consultative considerations, necessary training, budgetary needs, investigative tactics, use of detection tools, automation potential, required skill sets and personnel needs, and a stated degree of commitment.
      Speakers:
      10:10 AM  -  11:30 AM
      504. Auto Accident Referral Network Schemes
      This session will provide valuable insight into the infrastructure of auto accident referral network schemes and the impact they have on the frequency and severity of both PIP and casualty claims. The speakers will outline successful strategies SIUs can use to investigate, disrupt, and defeat these schemes, with a particular focus on the methods used to solicit automobile accident victims on behalf of the attorney and provider participants and the methods used to fund these schemes.
      Speakers:
      11:30 AM  -  1:00 PM
      Prize Drawing and Lunch
      1:00 PM  -  2:20 PM
      State Fraud Bureau Management Panel Discussion
      In this general session, senior management from four state fraud bureaus will cover topics that include trends in their jurisdictions, major case development, referral activities, resources, case volume, and their strategic partnership with NICB. In addition, the fraud bureau interaction with the SIU community is a key ingredient in the effort to resist insurance fraud, and this session will offer attendees the opportunity to pose questions and provide commentary. Attend this session and be part of the discussion.
      Moderators:
      2:20 PM  -  2:50 PM
      Refreshment Break
      2:50 PM  -  4:10 PM
      601. Premium Fraud and the Underground Economy
      In this session, a national expert will address and explain the link between premium fraud and tax evasion; discussing how to uncover, investigate, and prosecute it; and sharing two major premium fraud prosecutions. One of the cases was the largest premium fraud case in San Diego history. The $6 million case involved a janitorial company operating in the best hotels throughout Southern California. Using shell corporations to hide payroll, millions of dollars were stolen. The second case study was the first prosecution of its kind in California and perhaps the nation. A restaurant owner hired several college students. After a “training” period was concluded, the students were fired and not paid. This wage theft and unreported payroll was used to prove premium fraud and payroll tax evasion.
      Speakers:
      2:50 PM  -  4:10 PM
      602. SIU through the Eyes of the Adjuster
      SIU operations are structured to take assignments from the claim-adjusting staff and conduct a detailed fact-finding mission to gather intelligence that assists the adjuster in resolving the issues in question. In this session, a panel discussion will delve into the process from the eyes of the assigning adjuster. Sit in on this discussion and hear about training issues, cycle time pressures, the needs of the customer, regulatory concerns, and some “out of the box” thinking on how best to collaborate on these sensitive assignments.
      Speakers:
      2:50 PM  -  4:10 PM
      603. SIU’s Management of Brand Protection: Concerns and Consequences
      The main mission of property/casualty insurers’ claim departments is to protect policyholders with a contractual promise of indemnity at the time of a loss. In the pursuit of this mission, sensitive assignments are referred to SIU for more detailed investigation to assist in the prompt resolution of claims. In this session, the importance of the general practices of fairness, sincerity, investigative protocol, and brand protection will be discussed, with speaking points that will touch on investigative origination, timeliness, great customer service, and the avoidance of unnecessary risk.
      Moderators:
      2:50 PM  -  4:10 PM
      604. Automotive Theft, Security, Identification, and Data: A GM Perspective
      This presentation will be an update on how best to manage and leverage vehicle technologies to resist insurance fraud and fight vehicle crime. A national expert from General Motors will discuss topics such as immobilizers, alarm systems, steering column locks and other theft-deterrent features, innovations in VIN labeling, reading key fobs, cybersecurity, vehicle theft trends (such as relay attacks), OnStar as an investigator’s ally, and much more. GM wants to know how it can best support the needs of managing these types of assignments, so come with your questions and suggestions. This is sure to be an informative session.
      Speakers:
    • Wednesday, March 13, 2019
    •  
      8:00 AM  -  11:30 AM
      Registration
      8:00 AM  -  8:30 AM
      Continental Breakfast
      8:30 AM  -  9:50 AM
      Senior Claim Panel Discussion
      The mission of a claim department is to resolve loss issues in a great customer service setting and do so with the greatest degree of speed and accuracy possible. A reality of this process is the identification, investigation, and resistance of potentially misrepresented claims. That process must take place in concert with that main mission. In this moderated general session, panelists with senior-level claim management experience will discuss the issues involved in this coexistence. Points of discussion will include ownership, oversight, response, regulatory compliance, brand protection, and the synthesis of agendas within a large company. Questions and comments will be welcomed so attend this session and weigh in.
      Moderators:
      9:50 AM  -  10:05 AM
      Refreshment Break
      10:05 AM  -  11:30 AM
      Fraud Exposure from a Former Perpetrator’s Perspective
      Insurance carriers constantly assess their risk exposure, practicing this discipline daily by not only looking at coverage applications and claims but also process and procedure. Within the anti-fraud function, this same inquiry takes place by examining and testing discover misrepresentations on individual losses and detecting potential control failures. Large-scale schemes always start off as small operations while the coconspirators build out their business model. As that model is perfected and the working confederation is assembled, the operation “hockey sticks” in billing increase while carrier exposure skyrockets. In this general session, a seasoned SIU investigator and a former perpetrator discuss how those nefarious operations are built and how they flourish. Attend this session and hear firsthand how it was done and be better prepared to identify and resist these types of scams.
      Speakers:
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