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J. C. Owens Global Institute

Global Investigation Training Providers

 

Global Life and Health Insurance Anti-Fraud Professionals – GLHAP

 

“Providing claims investigation solutions every radius of the globe.”

 

                            _________________________

 

Certified Life and Health Insurance Fraud Investigator (CLHFI)

Certified Life and Health Insurance Anti-Fraud Consultant (CLHAC)

 

                           ___________________________

 

EMERGING PROFESSION REQUIRING PROFESSIONAL WORLDWIDE

 

Program objective

 

The objective of the program is to produce a pool of trained, knowledgeable, skilled and certified life and health insurance fraud investigators in every nook and cranny around the world. The certified professional investigator effectively investigates suspicious life insurance claims from the simple scenario of contrived supporting documentary proofs to the complex scenario of body substitution, when a corpse is produced and there is a burial site/tombstone. They should be able to investigate claims involving such policies as follows:

 

·         Whole Life Insurance

·         Term Life Insurance

·         Group Life Insurance

·         Accidental Death & Dismemberment (AD & D)

 

The life and health insurance fraud investigator should effectively review or examine health insurance claims or audit medical and treatment records for fraud. They should be able to uncover the facts in fraudulent foreign health claims whether they involve the simple scenario when the provider (medical clinic, hospital or other paramedical facility) does not physically exist to the complex scenario, when the physician or provider had connived with the policyholder to contrive the claim documents. The health insurance-related policies include the following:

 

·         Individual Health Insurance

·         Personal Medical Insurance

·         Group Health Insurance

·         Travel Insurance (Emergency Medical Expenses)

·         Hospital Confinement / Indemnity

·         Living Needs Benefit Insurance

·         Workers Compensation Insurance

·         Disability Insurance

·         Personal Accident Insurance

·         Personal Accident Liability

·         Critical illness / Care

·         Dental Insurance

 

An effective life and health insurance fraud investigator should be able to report professionally on their investigation and/or audit work. A standard report is that which conveys the findings succinctly for the principals as well as for the third party including the court in the case of litigation.

 

For the local HMO claims, the Investigator should independently investigate and audit such claims to the satisfaction of the principals.

 

With the pool of trained, knowledgeable and certified professional investigators around the world, the global life and health insurance industry will begin to resolve the present challenges of dearth of relevant professionals and reduce the estimated US$5 trillion local and international fraud per annum. Further, the local health insurance and Health Maintenance Organization (HMO) network will find resolution of the present quagmire in combating the challenges posed by unscrupulous physicians who contrive treatment records to defraud the network.

 

Program materials

 

1.    Handbook: Uncovering Fraudulent Foreign Life Insurance Claims – Vol. 1 (Incorporating lessons for Claims Examiners and Investigators worldwide)

ISBN 978-0-9912350-1-8

Available on this web site:

Click here to purchase

Also, available on Amazon.com

 

2.    Examining and Investigating Foreign Life Insurance and

Accidental Death Claims: The Workbook

(The Definitive Guide for Claims Examiners and Investigators in

examining and investigating foreign life insurance and

accidental death claims worldwide)

ISBN 978-0-9912350-5-6

 

3.    Handbook: Indicators Of Fraudulent Foreign Health Insurance Claims

(Analyses of 53 indicators of fraudulent foreign health insurance/medical expenses claims distilled from over 5,000 fraudulent claims investigated in Africa, Asia, South America, Central America, the Caribbean, and the Middle East for insurers, HMOs, and travel insurance companies in the United States, Canada, Europe and Asia. They are enhanced with pictures and checklists of medical equipment for Claims Examiners and Investigators worldwide)

ISBN 978-0-9912350-0-1

Available on this web site:

Click here to purchase

Also, available on Amazon.com

 

4.    Articles: Relevant articles under the Anti-Fraud Journal

      Click here

 

FOR INSURERS’ CLAIMS EXAMINERS AND SIU INVESTIGATORS

 

5.    Indicators Of Fraudulent Foreign Health Insurance Claims: The

Workbook for insurers’ Claims Examiners and SIU Investigators

(The Definitive Guide for Claims Examiners and Investigators in

reviewing health insurance and medical expenses claims worldwide)

ISBN 978-0-9912350-4-9

 

FOR FIELD INVESTIGATORS

 

6.    Indicators Of Fraudulent Foreign Health Insurance Claims: The Workbook for Field Investigators

(The Definitive Guide for Field Investigators in conducting health insurance and medical expenses claims investigations worldwide)

ISBN 978-0-9912350-7-0

 

Job opportunities

 

The certified professional investigators will find ready work in the country’s health care/insurance delivery networks as HMO Investigative Auditor. Our contention is that every health facility or provider in all countries’ HMO network should be audited annually.

 

They may choose to work as Life and/or Health Insurance Fraud Investigator for global life, health and travel insurance companies and related organizations. They may also opt for self-employment.

 

-       You do the work that offers you satisfaction

-       You can work throughout your lifetime

-       You work around the world

-       You require only a laptop with Internet access

-       You can work from home and do not necessarily require an office

-       You can work on full-time basis or part-time basis

 

 

 

 

Those required to train include the following:

Certified Life and Health Insurance Fraud Investigator (CLHFI)

 

The program is open to the following:

 

Ø  College and university students undertaking any course of study.

 

Ø  High school diploma holders who possess accredited professional qualifications such as in insurance, accounting, finance, marketing, etc.

 

Ø  A holder of a Master’s degree or a Ph.D. degree in any course of study.

 

The candidates for the CLHFI designation must score 75% on the 200 objective questions drawn from the handbooks, workbooks, and the Anti-Fraud Journal. On passing the examination, they will be awarded the Certified Life and Health Insurance Fraud Investigator (CLHFI) designation. They can append the designation by their name such as follows:

 

 

Certified Life and Health Insurance Anti-Fraud Consultant (CLHAC)

 

The Certified Life and Health Insurance Anti-Fraud Consultant (CLHAC) is awarded to the candidate that has held the CLHFI for at least five years with unblemished record. Further, the candidate would show documentary evidence or proofs to have worked at least 100 (50 on life and 50 on health) assignments adjudged to meet set standards. There is no examination required.

 

The candidate will be designated in any of the two ways as follows:

 

For Ms. Amos above, there may not be any need to append the CLHFI by her name if she so chooses. The fact that she already has the CLHAC indicates she must have acquired the CLHFI designation. But she is at liberty to make the choice.

 

If you hold the CLHFI designation and are already working in the insurance office, you do not require to show evidence of having worked 100 investigative assignments. All you require to do is to show evidence of having worked in the claims area for five unbroken years and without blemish in respect of your ethical performance of the work and your integrity. 

 

 

 

Certificate, Continuing Professional Development Program (Certificate, CPDP)

 

Most of the articles and courses on our Anti-Fraud Journal are aimed at sharpening the skills of the life and health Claims Examiners, SIU Investigators, Travel Adjusters, and field Investigators. They cover the current fraud trends. The article or course earmarked for the CPDP for each year is noted accordingly.

 

We would reach out to the relevant professional associations and institutes around the world to encourage their members to update their fraud knowledge in their respective areas of work.

 

The assessment would be for the candidate to write an essay stating the lessons they gained from the articles and courses and the impact on their work. The assessment would be made by members of our Advisory Board. A score of 75% and more is required for the candidate to be successful. The successful candidate is awarded the Certificate, CPDP 2017 or whichever year that is applicable. The certificate is equivalent to 10 credit hours.

 

Benefits of obtaining the professional qualification

 

·         Members can log in and read the articles and courses on the Anti-Fraud Journal

 

·         The articles and courses on the Anti-Fraud Journal will be printed twice a year and made available to the members at 40% discount (value: US$50.00 per year). It will be published as follows:

 

           Journal of Foreign Life and Health Fraud

Incorporating Travel Fraud

ISSN 2324 9226

 

·         Our other professional publications outside the handbooks and the workbooks (see Resource Publication link) can be purchased at 40% discount of the advertised price.

 

·         The certified professional Investigators can earn up to US$1000.00 and more from a single investigative assignment.

 

Training Costs and Prices

Certified Life and Health Insurance Fraud Investigator (CLHFI)

For insurers’ Claims Examiners, SIU Investigators,

Travel Adjusters, and Field Investigators

Total cost: US$575.00

 

·         Examining and Investigating Foreign Life Insurance and

Accidental Death Claims: The Workbook

US$75.00

·         Uncovering Fraudulent Foreign Life Insurance Claims – Vol. 1

(Incorporating lessons for Claims Examiners and Investigators

Worldwide)

US$65.00

·         Indicators Of Fraudulent Foreign Health Insurance Claims: The Handbook

US$75.00

·         Indicators Of Fraudulent Foreign Health Insurance Claims: The Workbook

for Field Investigators

US$75.00

OR

·         Indicators Of Fraudulent Foreign Health Insurance Claims: The Workbook for insurers’ Claims Examiners and SIU Investigators

US$75.00

·         Access to Anti-Fraud Journal link

US$75.00

·         Examination: US$150.00

·         Certificate: US$60.00

 

Certified Life and Health Insurance Anti-Fraud Consultant (CLHAC)

Total cost: US$400.00

 

·         Assessment: US$250.00

·         Certificate: US$150.00

 

Certificate, Continuing Professional Development Program (Certificate, CPDP)

For insurers’ Claims Examiners, SIU Investigators,

Travel Adjusters, and Field Investigators

Total cost: US$375.00

 

·         Access to Anti-Fraud Journal link: US$75.00

·         Assessment of the essay: US$250.00

·         Certificate, CPDP: US$50.00

 

                            _____________________________

 

 

Interested in this profession?

By registration you have indicated your interest to study or train for the certificate or certification. Please, complete the form and submit.

Click here to register

 

 

 

CONTACT DETAILS

 

P. O. Box 72218

Thorndale, PA 19372-7218

United States of America

 

Tel: (610) 383-4117

Fax: (610) 383-7114

 

E-mail: info@foreignlifeandhealthfraud.com