MAINTAINING AN ETHICAL CULTURE AND MANAGING FRAUD
Managing fraud
Our aspirations for 2010:
We have embarked on a new economic crime programme, aimed at enhancing our capability to address the issue of crime in a holistic way. As part of this holistic approach we will move away from the restrictive concept of fraud and focus on broader economic crimes. The programme will concentrate on the following:
- Deterrence and governance frameworks and policies
- Ethics management
- Stakeholder engagement, awareness and training
- Risk management and process improvement (to address opportunistic fraud)
- Intelligence capability (to address professional fraud)
- Fraud response unit
- Fraud policy
- Zero-tolerance policy
- Investigation methodologies and protocols
- Ongoing communication and reporting (internet, intranet, blogs, management reports, etc.)
- Stakeholder engagement and events
- Specialised induction and training
- Strategic and process risk identification
- Strategy for fraud management for areas that are not part of Santam’s system
- Root-cause analysis of investigations (post-fraud control reviews)
- Implementation of system-automated fraud detection controls at business process level (red flags and exception reporting)
- Oversight of management-agreed actions
- Due diligences of employees and suppliers (acceptance and ongoing)
- Surprise audits
- Investigation and implementation of new technologies to generate fraud propensity scores (at policy inception, amendment and claim stages) through predictive modelling, voice stress analysis, credit ratings, and client and broker ratings.
- Queries and analysis of internal and external databases, and unstructured data to identify networks, organised crime activity, areas of vulnerability, and crime patterns or trends in the insurance industry
- Social network analysis and neural networks
- Intelligence needed to support the fraud response unit and to address fraud at process level
- Secure and trusted incoming fraud reporting channels
- Collaborative, effective and efficient investigations
- Effective case management system
- Facilitate appropriate convictions
- Cyber forensic capability
We hope that through these various initiatives – such as our risk management processes, our new Whistle Blowers Policy, the fraud reporting incentive scheme for staff, our awareness campaigns, our use of technology to gather fraud intelligence and our fraud response unit – we will be able to facilitate an effective economic crime - resistant environment.
