Indicadores de fraude en el sector asegurador: análisis de la intervención de las entrevistas especializadas en reclamaciones sospechosas durante el 2018

Abstract

Understanding the inherent variety of insurance company risks, this systematization of experiences focuses on the technique of specialized interviewing as a preventive measure against fraud attempts, warning that the collection of an insurance policy may be an opportunity to obtain a benefit through a deceptive act. The objective of this approach was to explain the scope of the specialized interview in the collection and analysis of fraud indicators presented in claims to the insurance sector, in cases reported during 2018. To this end, a database was constructed with variables on the claimant, the characteristics of the claim and the result of the interview. A total of 126 cases were obtained, and an analysis of the descriptive results and a qualitative analysis were carried out. The results revealed that 65.9% of the cases corresponded to an inconsistent report, showing that the specialist interview contributes in a significant percentage to determining inconsistencies in the version, little evidence of the real occurrence of the incident or substantial inaccuracies in the facts. Likewise, the elements related to the cases qualified as inconsistent were described, finding that some generalities can be established which are shared in the cases and which are linked to the economic solvency of the claimant, the report of the incident or the concealment of information due to the nature of the same. This systematization of experiences was intended to show the importance of this technique in determining the quality of the testimony on an incident submitted.