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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.”

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Certified Health Insurance Fraud Investigator (CHFI)

Certified Health Insurance Anti-Fraud Consultant (CHAC)

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EMERGING PROFESSION REQUIRING PROFESSIONALS WORLDWIDE

 

Program objective

 

The objective of the program is to produce a pool of trained, knowledgeable, skilled and certified health insurance fraud investigators in every nook and cranny around the world for the local and international insurance industry. The health insurance fraud investigator should effectively investigate health insurance claims and audit medical/treatment records. The professionals should be able to uncover the facts in medical documents around the world under such policies as follows:

 

·         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

 

The professionals should also be able to investigate claims from the simple scenario when the provider (medical clinic, hospital or paramedical facility) does not physically exist to the complex scenario, when the physician or provider has colluded with the policyholder to contrive the claim documents.

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

 

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

 

With the pool of trained, knowledgeable and certified professionals around the world, the global life and health insurance industry as well as the travel insurance industry will begin to resolve the present challenges of dearth of professional investigators and reduce the estimated US$5 trillion fraud per annum.

 

Further, the local health insurance and Health Maintenance Organization (HMO) network will find some resolution of the challenges posed by unscrupulous local physicians who contrive treatment records to defraud the network.

 

Program materials

 

1.    Indicators Of Fraudulent Foreign Health Insurance Claims: The Handbook

(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 this book

Also, available on Amazon.com

 

2.    Articles: Relevant articles under the anti-fraud journal link:

Click here to read articles  

 

Additional: For insurers' Claims Examiners and SIU Investigators

 

3.    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

Available on this web site: 

Click here to purchase this book

Also, available on Amazon.com

 

 

                                                 OR

 

Additional: For Field Investigators

    

4.    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 work as Health Insurance Fraud Investigator in the global life and health insurance industry as well as the travel insurance industry.

 

They may also find work in the country’s health care/insurance delivery network as Health Insurance Claim Investigator or HMO Investigative Auditor. Our contention is that every health facility or provider in all countries’ HMO network should be audited yearly.

 

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 Health Insurance Fraud Investigator (CHFI)

 

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 CHFI designation must pass the relevant examination. This would comprise 100 objective questions drawn from the relevant handbook, workbook, and the Anti-Fraud Journal. A score of 75% or more is required for the candidate to be adjudged successful. They can append the designation by their name such as follows:

 

 

There are two routes or options for the CHFI designation as follows:

 

Ø  The SIU Investigators, Travel Adjusters, and Field Investigators Option

 

OR

 

Ø  The Field Investigators Option

 

Each candidate will choose one of the two routes or options.

 

Certified Health Insurance Anti-Fraud Consultant (CHAC)

 

The Certified Health Insurance Anti-Fraud Consultant (CHAC) is awarded to the candidate that has held the CHFI designation for a minimum of five years with unblemished record. Further, the field Investigator candidate would show documentary evidence/proofs to have worked at least 100 investigative assignments adjudged to meet set standards. There is no examination required.

 

For our Mr. Ahmed above, he would upon acquiring the CHAC be designated in any of the two ways such as follows:

 

 

For Mr. Ahmed there may not be any need to append the CHFI by his name if he so chooses. The fact that he already has the CHAC indicates he must have acquired the CHFI. But he is at liberty to make the choice.

 

If you hold the CHFI designation and work 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 to your ethical performance of the work and your integrity.

 

 

 

Certificate, Continuing Professional Development Program (Certificate, CPDP)

 

Most of the articles and courses on the Anti-Fraud Journal link 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 the 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 certification

 

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

 

·         The articles 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 professionals can earn up to US$1000.00 and more from a single investigative assignment.

 

Training Costs and Prices

 

Certified Health Insurance Fraud Investigator (CHFI)

 

For insurers’ Claims Examiners, SIU Investigators, and

Travel Adjusters

Total cost: US$w360.00

 

·         Indicators Of Fraudulent Foreign Health Insurance Claims: The Handbook

US$75.00

·         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$100.00

·         Certification: US$35.00

 

Certified Health Insurance Fraud Investigator (CHFI)

For Field Investigators

Total cost: US$360.00

 

·         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

·         Access to Anti-Fraud Journal link

US$75.00

·         Examination: US$100.00

·         Certification: US$35.00

 

Certified Health Insurance Anti-Fraud Consultant (CHAC)

Total cost for assessment and certification: US$300.00

 

·         Assessment: US$200.00

·         Certification: US$100.00

 

Certificate, Continuing Professional Development Program (Certificate, CPDP)

For insurers’ Claims Examiners, SIU Investigators,

Travel Adjusters, and Field Investigators

Total cost: US$350.00

 

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

·         Assessment of the essay: US$250.00

·         Certificate, CPDP: US$25.00

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Interested in this profession?

 

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