CIFI study plan
CIFI · Give each week a clear focus.
8 weeks · About 6 hours per week
Insurance fraud detection
Map the full fraud-detection lifecycle from first notice of loss through referral to SIU
Identify and categorize red flags across auto, property, health, and workers' compensation claim types
Differentiate hard fraud, soft fraud, and opportunistic exaggeration with original examples
Build a personal red-flag index card set you can recall without notes
Your checkpoint
A one-page red-flag taxonomy covering at least 25 indicators sorted by claim type and fraud category
Insurance fraud detection & Insurance fraud investigation
Explain how analytic scoring, anomaly detection, and link analysis surface suspicious claims
Trace how a detection referral becomes a formal investigation file
Evaluate the limits of detection models, including false positives and bias risk
Draft referral criteria that distinguish suspicion from accusation
Your checkpoint
A written case triage memo applying detection criteria to three hypothetical claim scenarios you invent, with a referral decision for each
Insurance fraud investigation
Sequence the investigative steps from case opening through evidence collection and reporting
Classify evidence types and apply chain-of-custody principles to each
Plan a structured witness and insured interview, including question ordering and documentation
Summarize the legal boundaries on surveillance, recorded statements, and data access
Your checkpoint
An investigation plan template plus a completed mock case file outline with evidence log and interview outline
Insurance fraud investigation & Insurance fraud deterrence
Assess credibility of statements using consistency, corroboration, and motive analysis
Draft findings in a defensible report format separating fact, inference, and conclusion
Connect investigative outcomes to downstream deterrence levers
Compare referral-to-prosecution pathways and restitution recovery options
Your checkpoint
A full mock investigation report of 3-5 pages with findings, evidence references, and recommended disposition
Insurance fraud deterrence
Design preventive controls across underwriting, claims intake, and payment stages
Quantify deterrence value using loss ratios, recovery rates, and cycle-time metrics
Explain how public messaging, prosecution referrals, and vendor oversight change claimant behavior
Distinguish deterrence from detection in control design decisions
Your checkpoint
A fraud deterrence control matrix mapping at least 10 controls to the fraud risk each one reduces and the metric that monitors it
Claims fraud law and defense
Identify the elements that must be proven for common insurance fraud theories
Compare civil remedies, criminal referral standards, and burden-of-proof differences
Outline defenses including materiality arguments, intent challenges, and claim-handling errors
Evaluate how documentation quality affects defensibility in litigation or arbitration
Your checkpoint
A comparison chart of civil versus criminal fraud elements, remedies, and burdens with a practice-application note for each row
Ethics and professional standards & Claims fraud law and defense
Apply professional standards and codes of conduct to realistic conflict scenarios
Analyze ethical tension between claim denial pressure and thorough investigation duty
Prepare to give testimony that stays within the investigator's factual scope
Detect and correct bias, overreach, and privacy missteps in an investigation narrative
Your checkpoint
Three written ethical dilemma analyses using a structured framework, plus a one-page testimony do-and-do-not guide
Insurance fraud detection & Insurance fraud investigation & Insurance fraud deterrence & Ethics and professional standards & Claims fraud law and defense
Integrate all five domains into a single end-to-end case walkthrough
Retest weak areas identified in milestone checks and log corrections
Practice timed retrieval of key definitions, legal standards, and control types
Consolidate a final one-page distillation sheet per domain
Your checkpoint
A completed full-length practice assessment with a written error analysis naming each missed concept and the corrected rule
Milestones
Week 2: Without notes, list 20 red flags and explain how a detection referral becomes an investigation file
Week 4: Produce a defensible mock investigation report reviewed against an evidence-and-findings checklist with no unresolved gaps
Week 6: Explain civil versus criminal fraud elements and name at least three affirmative defenses from memory
Week 8: Score at or above 80 percent on a full-length practice assessment, with every missed item converted into a corrected note