Suspicious insurance claims have familiar characteristics. The insurers have collated these characteristics into lists to be used in claim assessments to determine whether further professional and scientific investigations are necessary. These lists are commonly referred to as “red flags” or “indicators” of fraud.

Red flags are linked to the nature of claims or the type of the insurance fraud, for example, false or inflated theft repair claims, staged accident, billing fraud, fake death claims, falsified beneficiary claims, fake disability claims, forgeries, and workers’ compensation.

When three or more of these red flags are found in the process of assessing a claim, a threshold is met for recommending further professional forensic investigation. The existence of red flags is not proof of fraud. However, it is a signal to the adjuster to request for further investigation to either prove or disapprove the fraud.

The role of fraud investigators is therefore critical to the insurance sector. The investigators are responsible for collecting, processing and analyzing evidence of insurance fraud allegations. They help ensure that the proved suspicious fraud claims are rejected, and suspects of such fraud are prosecuted successfully.

The Insurance Act, Cap 487, Laws of Kenya prescribes that Insurance Investigators must be licensed. Therefore, insurers, and other stakeholders in the industry such as advocates, auctioneers, adjusters, and the general public should consider engaging licensed investigators to aid in proving or disapproving fraud.

At Riskhouse International, we are licensed by the Insurance Regulatory Authority (IRA). We have a team of professional investigators who utilize forensic tools, techniques and scientific analysis to investigate fraud. We also conduct awareness and readiness training on the red flags to stakeholders in the insurance industry.

Technology as a business enabler, currently plays a very critical role in small, medium, and multi-national businesses. Business stakeholders across industries must advance controls and take cyber resilience into consideration starting from the technical users to the board of directors.

Financial organizations and different industries are losing millions of monies in the hands of cyber hackers which causes damages and losses to businesses. Research indicates that businesses lose up to 400 USD every minute. It is therefore incumbent to include Cyber Security and Digital Forensic department in decision making meetings to enhance the tone at the top on strategies relating to enhancement of system security while conducting business.

Cases of system hackers are both internal and external. Case in point, mobile loan applications and wallets which are commonly used in business transactions are largely targeted by cyber hackers. The hackers identify loan apps on float, send traffic and compromise the mobile API (Application Programming Interface) for fraudulent transactions. No one thinks about cyber security until the incident occurs.

Despite the foregoing, the enactment of Data Privacy laws has triggered a lot of discussion on the implementation of data privacy in the Fintech industry. Globally, Denmark is ranked as the most cyber-safe country with a score of 8.9 on the cyber security index. The ranking is based on the combined data from different cybersecurity indices for countries in terms of their exposure to the crime. In Africa, Mauritius is ranked top and 17^th globally, Egypt is second followed by Ghana in the cybersecurity index and resilience.

Kenya is ranked 5^th in Africa. This is encouraging and an indication that there is room to ascend to the top. This will be attained by understanding cyber resilience, risk impact, detection and prevention starting from the Board, the Management and Staff.

Data security awareness should be the language in small, medium, and multi-national firms. Training on digital forensic, cyber security resilience and data privacy protection will enable us as a country to handle cyber-attacks. This is the only gateway to sustained business growth.

At Riskhouse, our team of experienced professionals will provide you with a framework that covers information security management, risk awareness, users and processes training on cybersecurity resilience, vulnerability assessment and penetration testing, system audit, business continuity plan, disaster recovery plan and digital forensic investigation on system frauds. We will be able to understand your system design architecture, risk universe, vulnerability exposure and implement corrective action.

By Michael O. Omuga, Digital Forensic and Cyber Security Manager.