Carriers, agencies, MGAs, TPAs, and brokers. Claims staff, agents, and adjusters spot problems long before an audit does.
Staged losses, inflated claims, or adjusters looking the other way.
Policies sold that customers did not need or understand.
Rates or risk data changed to hit a target.
Policyholder records viewed or shared without reason.
Many states expect insurers to have anti-fraud programs and to report suspected fraud to state authorities. Rules differ by state.
Insurers must protect policyholder information under federal and state privacy rules. Privacy complaints need a clear intake path.
Publicly listed insurers also fall under SOX Section 301 for accounting concerns.
General information, not legal advice. Have counsel confirm which rules apply to your organization.
Suspected fraud goes straight to your special investigations team.
Open the line to agents, brokers, vendors, and customers.
Tag reports by state so each one meets local rules.
Every view and action is logged and exportable.
Yes. You can open a separate tip line for outside fraud and route it to your SIU.
No. We receive and route reports. Your team or investigators decide what to do.
Yes. Rules differ by state, so reports can be tagged by state. Ask counsel what each state requires.