IASIU CIFA case studies
IASIU CIFA · Put your knowledge to work in context.
The Certified Insurance Fraud Analyst (CIFA) is a credential issued by the International Association of Special Investigation Units (IASIU). IASIU describes it as an accrediting process covering the topics that make an analyst well rounded across all aspects of fraud analysis, with a high standard for admission and testing that includes adherence to the IASIU code of ethics. It is aimed at people already working in insurance fraud analytics: applicants need at least three years of experience in insurance fraud analytics plus one of several education or experience routes, and an approved introduction-to-analytics course of at least 30 hours. The program was comprehensively overhauled in 2023, so older study material may no longer match. The IASIU CIFA case studies are 5 cases and about 2,875 words.
1Duplicate Billing Query at a Physical Therapy Network
An SIU analyst at a regional health insurer receives a referral about a physical therapy network with 6 clinics. The claims warehouse has 14,200 paid professional claims for 2022 in a table CLAIMS with fields CLAIM ID, MEMBER ID, PROVIDER NPI, SERVICE DATE, CPT CODE, MODIFIER 1, MODIFIER 2, BILLED AMT, PAID AMT, and DENIAL CODE.
600 words, about 3 min2Shared Phone Cluster in No-Fault Medical Claims
An analyst at a no-fault auto insurer is reviewing 2,300 personal injury protection claims paid in 2023. The Excel workbook has one row per claim with CLAIM NO, INSURED NAME, DATE OF LOSS, PROVIDER NAME, PROVIDER ADDRESS, PROVIDER PHONE, ATTORNEY NAME, ATTORNEY PHONE, PAID AMOUNT, and ADJUSTER NOTE.
579 words, about 3 min3Workers' Compensation Red-Flag Score with Limited Resources
A workers' compensation carrier insures a 300-employee construction firm. The SIU analyst pulls 620 indemnity claims from 2021-2023.
544 words, about 3 min4Agent Premium Remittance Gap During a System Migration
An analyst in an insurer's SIU is asked to review an agency after a customer complaint. The agency management system shows 240 policies sold by one agent in 2023.
571 words, about 3 min5Dwelling Fire with Financial Motive but Undetermined Origin
A homeowner reports a fire at 2:14 a.m. that caused 480,000 in dwelling damage.
581 words, about 3 min