Sakakini

Insurance Fraud is one of the top challenges that insurers are facing worldwide. While there are pricing pressures owing to slow economic environment, cutting back the Claims payout is one of the best means to increase efficiency and cut cost. From a strategic perspective also, carriers overall success to a large extent depends on the manner they treat their Claims function; for many insurers Claim processing efficiency is often their unique selling proposition. Reducing Claim leakages by effectively fighting against insurance Fraud and having a larger focus on recovery management can help insurers reduce their Claim cost.

This article is an effort to highlight five key areas that should be considered when building an effective Fraud management strategy.

1. Underwriting Prudence

Claims and Fraud management begin much before the Claim incident is reported. There are several indicators that can raise suspicion during the underwriting process. After the Claims are settled, the Claims data can positively impact the underwriting and rating functions. There is a need to incorporate more information into the underwriting decision-making process. The responsible use of data and information during the underwriting analysis is one of the most powerful weapons against Fraud.

The organization should know its prospective customers well to find fraudulent intentions beginning the review of sales proposal. An attempt should be made to dig deeper to verify identity and every application must be individually scrutinized. The goal of reducing Claim leakages should be kept in mind from the very beginning and the Fraud fighting mechanism should be activated from that moment.

2. FNOL Management

From a Fraud perspective, effective management of First Notice of Loss (FNOL) process is crucial for the insurance company. Through improved workflow, streamlining the processes and use of automation, insurers can identify the Fraud triggers and recovery possibilities early in the Claims cycle. The insurers should make use of early warning systems like, Voice Analytics for timely identification of Fraud. There are key factors for example, who reports the Claim (Claimant vs. Attorney Vs. anyone else); the time when the Claim is reported (Immediate vs. Delayed reporting); and the manner in which Claim is reported that can raise suspicion on the genuineness of the loss.

Any delay in identifying the Fraud triggers can have serious consequences later. If the decision to make an SIU appointment is late, the insurers can lose important eyewitness that can affect the Fraud analysis and the recovery possibilities. Any time lost during this stage will cause more than four times efforts, time and cost in the future. To fight the Fraud in an efficient manner, insurers have to be wiser and faster in comparison to Fraudsters. The use Data Analytics to narrow the possible number of Claims to be investigated for Fraud is vital. The insurers can then pay attention to those Claims, where high probability of Fraud exists.

3. Developing an Effective Claims Team

Effective deployment of resources is an important part of the overall Fraud management. Any organization that wants to effectually handle Fraud, must rebuild the Fraud investigative skills and capabilities. It should hire people with solid investigative skills to build a strong SIU unit for Fraud handling. By virtue of their experience, investigators who have worked for the FBI, Police and other investigative agencies can bring more value to the table.

The employees should be equipped with the necessary resources and a well-defined training program should exist. There should be online education and awareness programs through an Online Claims monitor on recent Fraud to the Claim handlers and investigators. Claims people should encourage feedback from the Claimants as a quality improvement tool. There should be a seamless link between Claims personnel and underwriters to make sure the overall business perspective is maintained and followed.

The aging of the baby boomers and the lack of skillful resources is resulting in heavy reliance on automation and investment in IT. Management should have a well-defined strategy to retain employees with key skills through the workload and work-life balancing. The goal of containing Claim leakages and rebuilding investigation skills and capabilities cannot be met unless the organization has a well laid out and forward-looking re-sourcing strategy.

4. Use of Technology

One of the problems being faced by Claims Organizations these days is the increased use of manual processes with limited use of tools and technology to manage processes. It is often found that the Claims Division in an insurance organization is one of the departments that are working with less-than optimal systems with huge maintenance cost. The need of Advanced Technology and Analytics in the Fraud handling cannot be over emphasized. The insurers should develop an integrated Fraud program with full policy life cycle consideration having clear defined Fraud management goals that are aligned to the business model.

With the number of people using social media sites, increasing day by day, the insurers should even consider social network analysis. The integration of Claims systems with social networking sites can prove to be an effective tool for Fraud detection. For insurers where the fraud leakage is on the higher side, it can even consider integration of IT systems with outside law enforcement agencies’ like the FBI, Interpol and DMV. The automation of the decision-making process based on business rules can also help in streamlining and standardizing the Claims process.

5. Information Sharing

Often it is found that different functional areas within an insurance organization do not talk well with each other. Thus, there is a greater need to strengthen data sharing between various departments specially, Underwriting, Claims and Finance. There might be similar Fraud patterns and issues across other lines of business, like Workers’ Comp, Commercial Auto and Crime. Having access to look across different coverage types for common behavior will be critical to success when combating Fraud. Besides, the companies should collectively work towards the maintenance of Fraud databases to have all the information in one place. This can aid in the analysis of Fraudulent Claim by comparing with old Frauds and grow the institutional knowledge and capabilities of the Fraud management.

There should be a centralized Fraud module where the findings and reports from Claim handlers and investigators are documented and available for anytime review. With Fraudsters becoming more sophisticated in their approach, there is a greater need for increasing industry collaboration and sharing of leading practices among insurers to combat Fraud.

“Life is not a fist. Life is an open hand waiting for some other hand to enter it.” Elie Wiesel

Some people might think that the answer to the question of “do we really need each other” has already been answered with the opening quote yet I’ll bet that some people will defend their stance on keeping their fists closed and close to their sides.

What does it mean to stand with an open hand and wait for another hand to enter it? The first word or feeling I come up with is vulnerability.

The Merriam-Webster dictionary defines vulnerability as “being capable of or susceptible to being wounded or hurt; open to moral attack or temptation.” I also hear the word weakness in this definition.

Dr. Brene Brown is a vulnerability researcher. In her amazing, down to earth, no nonsense, authentic book Daring Greatly, Dr. Brown says,

“The perception that vulnerability is weakness is the most widely accepted myth and the most dangerous. When we spend our lives pushing away and protecting ourselves from feeling vulnerable, we let our fear and discomfort become judgment and criticism. Vulnerability is the core of all emotions and feelings.”

A lot of us tend to tie vulnerability to something dark like fear, shame, grief, disappointment. What if we did allow ourselves to feel all of those emotions in their proper place and space and time? Dr. Brown spent over a decade researching this question and more and she found that

“Vulnerability is also the cradle of the emotions and experiences that we crave. It is the birthplace of love, belonging, joy, courage, empathy, and creativity. It is the source of hope, accountability, and authenticity. Vulnerability is uncertainty, risk, and emotional exposure.”

“Courage is the most important of all virtues, because without courage, you cannot practice any of the other virtues consistently.” Maya Angelou

But why need each other? Why be so vulnerable in the presence of another person? For one thing it pushes each of us to become a better version of ourselves.

Here are a few thoughts on why needing each other is a great thing:

1- Community: It may take one person to come up with a plan or an idea but it will take many other people to help implement and bring that plan or idea to life. Each individual person does not have all of the answers. Even though answers to questions are easier to find these days through the internet we each have to realize that someone placed the information on the internet for us to find and someone else did a lot of work to create the answers we are seeking. Before you know it you have amassed a community or village of people to help you make your idea or plan take flight.

“Strength lies in differences, not in similarities”
Stephen R. Covey

2- Accountability: Just like a coach holds his/her players accountable to learn the sport they are playing and the position they are attending; just like a life coach holds his/her client accountable to the agenda being worked on so too do other people play important accountability roles in each of our lives and thank goodness they do. Think about any change you want to make in your life or any time you need to just get through a hard time and now think about the people who help you change or get through. With just the right question and just the right amount of care you know, in the end, you couldn’t have done it without the help from someone important in your life. A great example might be a surgeon or doctor that helps us get well when we need surgery or medical care right away.

“The only way we succeed as a group is not simply following directions, but in keeping each other accountable for our actions.”
A.J. Darkholme, Rise of the Morningstar

3 – Competition: A lot of people thrive on competition. Think of all those marathon runners each year that prepare and train and focus so intently on winning that long arduous foot race. Where is the glory of winning if we are only running against ourselves? Where is the fun in competition if we have no one that we want to compete against?

“Have you ever felt the longing for someone you could admire? For something, not to look down at, but up to?”
Ayn Rand

4 – Achievement: You passed the hardest test ever! You climbed the highest mountain in the world! You won the Nobel prize for your research or publishing! You worked so unbelievably hard and you finally graduated with honors and a doctorate degree! Can you imagine feeling so incredibly great about your achievement and there is not one single person to celebrate with?

“there is nothing more beautiful in life
than celebrating the talents, dreams,
joys, and accomplishments of another being
to see – and call attention to – the best in someone else… ”
Kate Mullane Robertson

5 – Love: It is important to find reasons and completely believe those reasons to love ourselves first so that we can love other people. However, it is also important that someone love us first and teach us how to love in order for us to know what it feels like and how to give it to others. Without love where would we be as a species? Love does make the world go round.

“Having someone wonder where you are when you don’t come home at night is a very old human need. ”
Margaret Mead

One of the very first lessons I learned when I was going through my coach business training was that it will always be important to have my own coach, whether for something specific or in general. The importance of that being the fact that you immerse yourself in the language and processes of coaching and at the same time work through your own personal road blocks so that you can be what your clients need you to be with empathy, authenticity, experience and hope. There are coaches for just about any life situation. For example there are coaches for teenagers, coaches for executives, coaches for life in general, coaches for relationships, leadership, Alzheimer’s, diabetes, ADHD, etc. I have a coach for coaching itself and a writing coach for the book I am working on and I have a supervisory coach. I couldn’t have come so far in my coaching practice without the help, guidance and love of all those mentors, classmates and colleagues. All it took was courage and vulnerability to let the work I wanted to accomplish begin to work its magic.

So I am a life, career, heart, and soul coach. My deep satisfaction and purpose comes from being able to take the scattered puzzle pieces of the life’s journey you are on and help you put them together; help you create a life road map with places to stop along the way and appreciate all the splendor of all that you have already within you. To empower you toward whatever you set for your life purpose, passion and potential. What I ask of you is to be vulnerable with me, have courage to stare your life in the face and create what you want from it. Everyone needs a little help now and then. That’s what I’m here for.

Why would you want to share those deep emotional parts of you and face the things you are most afraid of? Well, because that is what I ask of myself and so I have personally been where you are and can create a safe space for you to explore where you want to go; who you want to become. I need to go to those darker more vulnerable places too so that you know without a doubt that I am on your side, walking with you on your journey.

“When you stand and share your story in an empowering way, your story will heal you and your story will heal somebody else.” Iyanla Vanzant

Our life experiences are not meant for only us. Our life experiences are meant to not only teach us something important but also to be shared so that someone else might learn as well. On your journey please know that I honor you in your pursuit of purpose and passion and personal growth. Your courage and vulnerability to share, stand and influence another person is a cause for celebration.

Call to Action

Who is most important in your life? Why?

If you allowed yourself to vulnerable with this person how might the relationship benefit?

At what times during your life moments do you choose to hold back, stand alone, not need anyone?

When have you noticed that having someone on your side has helped you achieve in a big way?

If you would like to start creating your own road map toward your passions, if you would like help in sorting through your life’s puzzle pieces please email to lisa@journeyoncoaching.com or visit our website at http://www.journeyoncoaching.com

I was in good spirits. It seemed a really fine day, the weather appeared promising, and, for no reason at all, as I started getting ready for university, I decided I’ll dress a bit more nicely today, and wear a little more jewelry, and just a little more makeup than I usually do.

As I stepped outside and stood, waiting for my university van to pick me, I noticed creatures belonging to the opposite gender checking me out as if I was either a fresh new playboy issue or a shiny new toy featured on eBay. I felt my blood boil, I wanted to make them suffer, I just wanted them to stop throwing those disgusting glances toward me, all this while abusing them in a really fancy language in my mind which, after all, was all I could do, being a girl raised in a society that raises girls like they are nothing more than commodities, and taught to act just like a non-living thing; have no real rights, no feelings, no voice for herself, and no opinions.

Sadly, the glances continued and followed me through the whole day which had already been ruined. It’s not that I had never been checked out and stared at before, but something was just more disgusting about the stares that came my way that day, and that is the day when I thought, for the first time, that why is it so. Why is it justified for men to stare at us however they want, why is it not a big deal when the ‘rishta‘ aunties fish through our photos looking for the most suitable face to fit the ego of the “larkay walas” and why is it okay for the boy’s family to visit our houses, enjoy hearty meals, take a complete outward examination of us and leave, only to send a refusal within a few days along with a lame excuse, thus tarnishing our self-esteem.

On another not so fortunate occasion, an ‘aunty‘ who lives in Australia came to visit me claiming that she had seen my photos and heard about me from her friend and was very sure that she wanted only me for her son. Anyway, I didn’t feel so wrong about putting efforts into looking nice that day so I did. She came, she saw, she ate, then she left. It was six months ago and we have never heard from her ever since. The only consequence that followed was me feeling low about myself and over-thinking for a good many days, doubting my ever so strong belief that I am a good-looking girl. The only good that came out of it was me deciding that this will not happen again and I flatly told my parents that I won’t let them put me on the shelf ever again.

Now that I think of it, it was stupid of me, and it is stupid of all the girls who let her parents manipulate them into displaying themselves in front of these people and let them benchmark their daughters as items of sale. It is stupid of us to buy into the age-old belief that marriage is the only life there is for us girls and it is crucial for us to get married at a certain age.

The only way to stop being viewed as commodities all over the planet is to stop considering ourselves as one. We have to change our thinking first before we can change others’ perceptions. We have to stop being the victims of society, we have to start being brave and raising our voices for our own selves at least, and we have to stop taking harassment of any sort, be it mere stares thrown our way. We have to stop selling our bodies as either actresses or porn stars or prostitutes, we just have to have respect ourselves and refuse! The only way to stop the world viewing us as commodities is to stop viewing ourselves as one, and emerging, not as empowered women, but as human beings in absolute control of their free will.

In today’s society there is so much noise that to compete you have to be louder in every aspect of your life. You are competing with social events and other distractions and most importantly what is influencing your decision-making and the barriers that make it a hard to reach your full potential. Your goal should be to create an identity for yourself that involves yourself with great leaders, and that channels your expectations and your goals and most importantly your power to control the influential lifestyle you’re seeking. It is very important to understand that you can’t have everyone as your friend you must select only a few and I mean only a hand-full of people into your environment.

What you need to accomplish is a ground game to access the necessary information from these groups of people you surround yourself with, and I’m talking about the LEADERS, the SMART, and most SUCCESSFUL, POWERFUL RISK takers that you can find. For there is where you will find many solutions and ideas. Once you discover these leaders in your circle, create firewalls around them by having the greatest relationship with them as possible, this will allow you to break into other markets of great leaders and people in the marketplace.

Example: Find the people who are really influential in the business that you want to start, and let’s say you don’t have the funds to start the business, which can ordinarily be tough. Find them and connect with them, grab their ATTENTION and don’t let GO! You have to pass the gate- keeper, so call them, email them and call them again and email them again and repeat! Sound persistent? You should be a billboard that they can’t stop looking at. Remember successful and powerful people who are very influential want to be surrounded by other people who want to be like them. If you are loyal to seeking their attention it will give them a sense of urgency to connect. However you must remember that these powerful and influential people here a lot of noise so you have to be louder than that noise, and quite frankly that will be your way of life once you build that relationship.

So be LOUD and go out to create a lot of noise and get the ATTENTION that you need to be POWERFUL and INFLUENTIAL to create the lifestyle you need for yourself. And don’t doubt yourself! And my question to you is are you going to go out there and be GREAT? And are going to STAY GREAT! Remember it’s all about the connections that have INFLUENCE!

The most fundamental of all human rights is the Right to Life. It is the most inalienable as it is enshrined in the constitutions of most countries around the world. However a critical look at most constitutional draftings shows an omission of sexual minorities. This is not surprising especially in African States where part of the colonial hangover were laws out rightly criminalising same sex relations with harsh penalties for those who indulged in the practice. We remember the arrogance of former Nigerian President Olusegun Obasanjo who said that there were no gay people in the country. The coming out of Bisi Alimi in 2004 must have been a rude shock and affront with severe consequences on the man that dared to come out of the closet.

On July 9, Ahmed Ben Amor, the Vice-President of Shams, an LGBT group in Tunisia made an attempt on his life by consuming a large quantity of harmful drugs. This is indeed tragic and disturbing for human rights conscious Africans. While many constitutions uphold the right to life as earlier pointed out, many in the African continent are extremely homophobic and endorse the killing, maiming and beating of sexual minorities. There are no ugly consequences for the perpetrators of these human rights abuses with the police not helping matters especially as some law enforcement officers even shamelessly blackmail members of this vulnerable community.

Let us look at what made Amor take that extreme decision. He regularly received death threats and was contending with rejection from his family and society. The dominant religion, Islam didn’t help matters as well. With all these put together, let us be frank ‘Was his life really worth living?’ What was he really looking forward to when he got up in the morning? How did he feel when constant hate mails laden with death threats flooded his inbox and probably his phone via sms?

Some have even gone as far as condemning him for the suicide attempt and called for his prosecution on the grounds that suicide is equally a crime.

This is not the time to apportion blames but to show some love to not only him but the millions of others in Africa who are in similar conditions. How can we make life worth living and something to be enjoyed rather than endured for these sexual minorities? How can we stop the hate in all its ramifications and entrench sturdy punitive measures for hate apostles? How can we stop the forced anal examinations these men are subjected to alongside the frequent slurs that is their lot? Why should we prevent them from getting treatment for ailments including HIV? Why must we force them to go on exile far away from their families and loved ones just to be assured of the right to life?

Until we do all these, we have no right to judge and worse still condemn those who have been pushed to the wall and want to end the whole misery by taking their own lives? We should stop being hypocritical and make life a truly worthwhile experience for all irrespective of sexual orientation.

Our hearts goes out to him and we wish him speedy recover. We hope he lives long enough to witness the drastic reduction of homophobia in Africa.

One love from us all here!

Please visit http://www.africansagainsthate.com and make comments and useful contributions. You can also submit articles on how to end homophobia in Africa to anthonyademiluyi@africansagainsthate.com