SOLUTIONS
Investigation + fraud
Taking care of clients’ financial and reputational stability.
What we do
Most insurance claims are genuine. But our experience shows that not all claims are honestly presented — and that addressing suspect claims quickly and efficiently is crucial. Fraud prevention, detection, investigation and mitigation are critical components to a company’s financial and reputational stability. At Sedgwick, each claim is screened by our special investigations unit 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 comprehensive program is designed with innovative strategies that lead to claim insight and cost savings — identifying and settling genuine claims quickly, serving as stewards of our clients’ risk pools and reputations and continuing to enhance our services with innovative technology and market-leading data.
Our formalized special investigation unit (SIU) offers smart, integrated solutions that combine specific claim investigation techniques designed to support fraud mitigation.
OUR OFFERINGS
Red flag analytics and scoring technology
Our state-of-the-art scoring technology uses machine learning (ML) to identify red flags that may require further investigation.
Research and intelligence
Our SIU team conducts social media investigations, background checks, medical and facility canvassing, skip tracing, criminal, civil and asset checks, and extensive database mining.
Field investigations
Surveillance techniques include traditional mobile, on-site stationary device monitored remotely, or a combination of methods; virtual or in-person detailed statements; activity and alive and well checks; canvassing and other on-site investigations, as requested.
Fraud and regulatory compliance
We work to ensure regulatory compliance in the detection and reporting of fraud by reviewing suspect claims, scored claims, red flag analysis, consultancy with examiners, fraud investigations, state fraud submissions, and carrier regulatory reporting.
Vendor management
Along with our internal investigation team, our provider network extends coverage to more than 3,000 investigators across the U.S. We build and maintain a panel of experts with diverse backgrounds, including regional and national providers as well as certified MBE, WBE and VBE businesses. Our partners are credentialed to meet Sedgwick’s data security requirements, and insurance and licensing requirements — keeping our customers and their confidential data protected.
Quality assurance and impact
We conduct deep analysis of metrics, trends and benchmarking data to shape the direction of our actions and demonstrate the impact of our services.
Why choose Sedgwick?
- Diverse expertise across accounting, insurance and law enforcement
- Expertise spans across several insurance lines, including workers’ compensation, liability, disability, property and auto.
- Experience across multiple industries such as retail, hospitality, real estate, healthcare, manufacturing, banking and construction
- Red-flag analytics identify possible fraud early
- 98% client retention, 30%+ state acceptance rate and cost savings of 1M+ in the U.S.
Caring counts
Every day, thousands of people turn to Sedgwick when faced with a life-changing moment. They work for global brands that want to provide the best coverage for the people they value most. They are big and small business owners who need to get things back on track. And they are employees and consumers who need to know that they’re protected. We take care of them when they need it most, helping them get back on their feet, back on the road, back to business as usual — because caring counts.
Interested in our services?
NEWS AND INSIGHTS
THIS SERVICE IS AVAILABLE IN:
Australia
Denmark
Germany
Hong Kong
Ireland
Mauritius
Netherlands
Norway
Oman
Singapore
South Africa
Spain
Sweden
Taiwan
United Kingdom
United States
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Thought leadership • Regulatory updates • New solutions • News and developments