Fraud Investigations
Your reliable partner in fraud investigations.
Our fraud investigations unit uses industry-leading AI tools to quickly address fraud, waste and abuse across all business lines – reducing risk and delivering unmatched cost savings for your program.
Fraud prevention, detection, investigation and mitigation are critical components to a company’s financial and reputational stability. At Sedgwick, each claim is screened for fraud concerns and flagged when it requires a second opinion; if a concern is identified during the detection process, we immediately triage the claim to determine next steps; and if investigation is required, our fraud specialists deploy a variety of compliant and proportionate methods and tools, including desktop services and visits. We also offer fraud management consultancy.
Our approach to fraud
The prevention, detection, and investigation of fraud are essential for organisations in every industry. At Sedgwick, we possess up-to-date knowledge, utilise the most advanced techniques and apply the latest industry methods to identify risks early and protect organisations from financial and reputational damage.
All damages and claims are carefully examined for signs of fraud. When fraud is suspected, a triage is conducted to determine the most effective next steps. If further investigation is necessary, specialised fraud investigators are deployed. They use various methods, including digital analysis, file screening, home visits and fraud management consultations.
What we offering
- OSINT research
- Risk analyses and prevention advice
- Support in identifying and combating fraud
- Fraud investigation both on-site and remotely
- Assistance in civil proceedings
World-class investigative and fraud scoring expertise.
Red flag analytics and scoring technology
Our state-of-the-art scoring technology uses machine learning to detect fraud indicators. This information is captured in our proprietary case management system throughout the investigation so our experts can monitor trends and make strategic recommendations. And with viaOne, you get 24/7 access to this data as well.
Research intelligence
We work to uncover critical insights through social media investigations, background checks, medical and facility canvassing, skip tracing, criminal, civil and asset checks, and extensive database mining. Plus, our research findings are all documented in real time for you in our powerful information hub, viaOne.
Field investigations
Whether you need in-person or remote surveillance, our investigation techniques are tailored to each case and use the most advanced video technology, smart cameras and image forensics around. We also conduct in-depth interviews, activity and alive-and-well checks, canvassing and other on-site investigations as needed.
Fraud and regulatory compliance
We achieve maximum compliance by reviewing suspect and scored claims, red flag analysis, consultancy with examiners, fraud investigations, state fraud submissions and carrier regulatory reporting. Our team stays ahead of legislative changes, ensuring we always stay compliant when detecting and reporting fraud.
Vendor management
Beyond our in-house team of 80+ specialists, we partner with 3,000+ investigators globally from regional and national providers and certified MBE, WBE and VBE businesses. Our partners are credentialed to meet strict security, insurance and licensing requirements – keeping you and your data protected.
Quality assurance and impact
Using the most sophisticated data analytics tools, we regularly analyze key metrics, trends and benchmarking data to measure the impact of our services and refine our strategy. Our data-driven approach helps us deliver the best possible outcomes, with an average claim cost lower than 85% of industry competitors.
News & insights
Contact us about our fraud and investigation services.
If you have any questions about our methods or would like advice on fraud investigation, please contact our specialists.
Available in
- Belgium
- France
- Hong Kong
- Ireland
- Malaysia
- Mauritius
- Netherlands
- Portugal
- Singapore
- South Africa
- Spain
- United Kingdom
- United States
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