Control Reporting & Claims Process Guidelines & Counter Fraud

What is the GCG Requirement timeline for Claims Registration?

• Within 5 working days of claim notification

• Within 24 hours of claim notification

• Within 3 working days of claim notification

• Within 7 working days of claim notification

Which of these is NOT an example of Control Reports?

• Payments against staff policies

• Duplicate payments report

• Sanction Listing

• Adoption Rate Report

What is the required timeframe to sent a reminder for outstanding documents that was not forthcoming from original requested date?

• 14 days

• 7 days

• 5 days

• Sent reminder when conducting 120 days review

Zurich must advise the claimant in writing where claim is repudiated, stating the reasons for repudiation:

• 5 working days

• 7 working days

• 5 working days for Motor & 7 working days for NM claims

• 3 working days for Motor & 5 working days for NM claims

Initial reserve must be reviewed and updated within _____ upon receiving updated/new information/adjuster assessment:

• 14 working days

• 7 working days

• 5 working days

• 3 working days

TRUE or FALSE. Zurich Fraud Philosophy is “Zero Tolerance”.

• TRUE

• FALSE

Which of the following actions are expected from the Claim Handler in detecting Fraud claims:-        

I. Utilize the Fraud Checklist

II. Rely on Gut Feeling

III. Conduct Surveillance on the suspected Fraudster

IV. Check on Claims History

• I , II and IV

• I , III and IV

• I , II and III

• All the above

Which of the following actions is NOT the appropriate action to be taken if the Claim Handler suspected the claimant is committing Fraud claim:-

• Assign investigator to probe further.

• Escalate the file to Line Manager.

• Ignore it and proceed to make offer

• a.         Record the claim in the Fraud Reporting list as a Potential Fraud Savings.

Which of the following statement could be the impact of capturing wrong data:-     

I. Become an Audit Issue

II. Mistrust on the data and data analysis

III. Error in the KPI Report

IV. Error in the Regulatory Reporting

• I , II and IV

• I , III and IV

• I , II and III

• All the above

How many scoring in FIS is consider fraud?

• >50

• >100

• >350

• >500