Combating Insurance Fraud

When instructed by an insurer, an investigators task is to “validate” a claim. We are never paid or re-instructed on claims declined or avoided, but solely on our ability to deliver a prompt, professional validation service.

Claims are sent to us, most often because they contain what the industry calls “red flags”. These might be simply the type of claim, such as every stolen burnt out car being investigated as a matter of course.

The point we are making is that we are not bounty hunters and we do not have any targets to achieve. That said, it is widely acknowledged that an investigator looking to validate claims selected by trained claims handlers using the red flag system should produce a “ROI” of between 7 to 10, meaning that for every dollar paid to the investigator, there should be a saving in claims between $7 and $10.

Paragon’s ROI for one insurer for the period 1/7 – 30/9 this year was $15.74.