Contract SIU Services

SIU Compliance Solutions' experienced contract SIU staff is familiar with insurance industry, claims process, payment requirements, is well versed in various fraud schemes and defenses, utilizes the most recent technology available to detect, prevent and investigate fraud. They are keenly aware of the prosecutorial process and what must be obtained for a successful prosecution. Utilizing SIU Compliance Solutions' "pay as needed" contract SIU program can generally lead to better results at a lower cost than with a less experienced in-house SIU.

SIU Compliance Solutions' contract SIU staff offers:

  • In-depth knowledge of the insurance industry.
  • Insurance fraud investigation experience.
  • Law enforcement experience, particularly in fraud and criminal investigation.
  • Advanced technologies, including comprehensive SIU databases.
  • Proven record of generating significant cost savings.
  • Ability to measure, track and report outgoing cost savings.
  • Strong client references.
  • Results driven interaction with federal, state and local law enforcement, the NICB, state insurance departments and state fraud bureaus.
  • Processes to enhance the flow of information and communication between claims departments and SIU investigators.
  • Full compliance with state statutory requirements for SIU contract service providers.
  • Full state-mandated reporting capabilities.
  • Ability to seamlessly manage investigative and surveillance vendors including quality control.


SERVICES OFFERED

Anti-Fraud Compliance Services:


Anti-Fraud Evaluation
  • Review and evaluate client's current Anti-Fraud efforts and program against current regulations of all states of admission. Provide a detailed report with recommendations of cost-effective improvements which will meet or exceed all current regulations and statues.
  • Implementation of client approved improvements.

Anti-Fraud Plans
  • Anti-Fraud Plans: Prepare, Draft and file Comprehensive Anti-Fraud plans as required.

Anti-Fraud Annual Reports
  • Annual Fraud Reports: Correlate statistical information as may be required, Draft report and file with respective state or agency as required.

Anti-Fraud Referrals
  • Fraud Referrals: Summarizing and filing questionable claim reports as REQUIRED by State Regulators. A proper filing is critical for carriers to receive the benefit of Immunity from civil litigation.

Staff Anti-Fraud Policy & Procedure Manual
  • Draft and prepare Anti-Fraud Policy & Procedure Manual for distribution to all Anti-Fraud Personnel as required by regulators.

Anti-Fraud Training
  • Coordinate, provide and monitor online Anti-Fraud training for client's integral Anti-Fraud staff as designated by state regulators.
  • Provide On-Site Anti-Fraud training with our certified training staff.

Anti-Fraud Administrative Services
  • Monitors and maintains Anti-Fraud Training records.
  • Monitors Anti-Fraud bulletins, newsletters and distributes applicable information to client's staff.
  • Maintains repository for appropriate records of anti-Fraud activity for annual reports.
  • Assures all client integral staff, vendors and SIU personnel meet or exceed regulators annual training requirements.
  • Compiles client's Anti-Fraud statistics on a semi-annual basis.
  • Reviews and monitors new Anti-Fraud legislation or regulations.
  • Recommends and monitors client's fraud detection plans and public awareness plans.


Contract SIU Services:


Contract SIU Staffing
  • Provide experienced Senior SIU Investigative managers to be designated "Director of SIU" for the client and required support staff as needed.

Contract SIU Services
  • Assume full statutory responsibility for designated SIU responsibilities.
  • Handling premium, internal claims and external investigations from inception to completion.
  • Oversees all questionable claims investigations on client's behalf from inception to final adjudication
  • Updating and working with client's staff on cost-effective plans of action.
  • Determining and providing valid support for questionable claim referrals.
  • Assigns and monitors field assignments and surveillances.
  • Reviews any and all reports and surveillance tapes from vendors, provide vendor quality control and audit vendor's invoices.
  • Prepares, when requested, litigation prosecution worksheets.
  • Responsible for reporting and updating all events of each investigation as requested by the client.
  • Assists and provides support to client's legal staff as requested.
  • Availability to client's staff and respective vendor assistance 24/7.
  • Liaison, communications and correspondence with local and federal law enforcement agencies, carrier's SIU departments, Anti-Fraud organizations and Department of Insurance Fraud Units.
  • Provide support and services to client having designated legal units.
  • Support and attend Anti-Fraud programs provided by state and national insurance fraud organizations such as state DOI annual seminars, NAIC Anti-Fraud Committee meetings, NICB, National Coalition on Insurance Fraud, etc.
  • Monitor and maintain client approved Anti-Fraud vendor contracts and licenses for compliance reviews.