Legal Issues

Date As a fraud analyst the responsibilities include collecting and analyzing the facts of the case for evidence of fraudulent behavior. Experience in case investigation is necessary to accomplish this. The analyst must possess skillsets in veracity research and bin analysis to isolate correlations in the data or sample of claims. The analyst can then begin to formulate hypothesis based on the data that can either be proved or disproved. The investigator has to examine the scenarios given and determine the root cause for the appearance of fraud in the claim or claims.  The framework of the investigation needs to have a controlled environment to process the information in order to detect any possible instance of fraud as discussed by the National Criminal Intelligence Resource Center.

Skills required include familiarity with internal auditing of employees, business processes, and company policy. It is important to be able to interview and communicate with multiple levels within an organization from administrative, and agents to managers, supervisors, and other investigators. A background in accounting and financial actuary skills is also necessary to find any unusual activity in the financial records of the company or client claims. It is necessary to study many financial records and reports therefore it is a requirement to understand all types of financials from the annual report to individual monthly forecasts and day to day accounting data. Another requirement is to understand risks analysis and how to advise of risks associated with certain types of claims such as hard versus soft fraud cases (IFBCoakley, 2010). Direct experience includes underwriter responsibilities at several mortgage companies. Job experience in incorporating interviews of participants and processing multiple loans daily in the underwriting capacity.

Some benefits that can be provided by services include checking all valuations to insure they are in conformance with policy. Extensive travel expertise in the field to conduct research, investigates claims, and communicates with upper levels of management on the status of caseloads. Logging data is an aptitude to locate discrepancies in the records or communicate and trace inaccuracies on the part of client or legal precedent.

Background education includes a Bachelor Degree from UCLA with emphasis in Accounting and Managerial Finance, also received an education in Fraud Analysis from the IELEIA or International Association of Law Enforcement Intelligence (2010).

Intelligence Process and Plan of Operation
The intelligence process can be used in studying this CityPlus case. The process includes collecting, analyzing, processing and disseminating information for sole purpose of detecting fraudulent activity. In the CityPlus case, reviewing any commonalities among the attorneys, clients, or claim history would be the first part of collecting data (New York Criminal Justice, 2009).

A great deal of detail can be pulled from the claim history and public information already available for investigation. This type of open source intelligence, allows common themes to be reviewed including the make and models of the vehicles and vins involved, for example (SGAIM, 2010). Other facts that can be studied related to witnesses, car registration, and even doctors statements, car repairs or locations of the incident reports. Though this is a data gathering phase, all Intel is gathered for the purpose of evaluation and verification. It is at that point that the next phase of the process begins called analysis.

Analysis includes studying and assessing the claimants statement for discrepancies and clarification. It requires intense scrutiny of threats in the documentation presented by claimants. During this study, opportunities for disproving the claims are researched and documented. Process allows the careful deliberation of the details of the documented claim. Areas of vulnerability where there is a lack of support or evidence are carefully acknowledged and tested. Inaccuracies can often be highlighted through the analysis intelligence process.

Dissemination of information allows the sharing of facts to the defendant of the insurance company in order to bring to light issues with the claims. It is a time of exposing inaccuracies in the claims and providing the necessary evidence to disprove the validity of the claims either to the insurance company or legal entities.

Step One of the plan would be clearly stating the problem. What is the claimants position and how does CityPlus respond. From this point a team can be put together to gather data and open source intelligence to support CityPlus position.

Step Two would require an analysis of the data gathered to locate common areas between the various claims and how they are related.

Step Three is study and assessment of the documented results of the analysis.
Step Four would be presenting this information to CityPlus authorities and getting their feedback and input on next steps.