III IC-39 study plan

Map the full Fraud Risk Management in Insurance syllabus into a one-page topic tree showing the fraud risk management cycle from risk identification through monitoring and reporting

Define the core vocabulary of insurance fraud (moral hazard, adverse selection, opportunistic versus organized fraud, claims fraud, underwriting fraud, intermediary fraud, internal fraud) in your own words with one example each

Identify the main fraud typologies affecting life, health, property/casualty, and commercial lines, and note which lines carry the highest exposure

List the stakeholders in an insurer's anti-fraud framework (board, risk committee, claims, underwriting, compliance, internal audit, distribution, external bodies) and state each one's role

Explain how fraud risk appetite is set and cascaded into tolerances, thresholds, and escalation triggers

Describe the components of a fraud risk governance structure, including three-lines-of-defense roles and the fraud risk committee's mandate

Distinguish fraud risk assessment from enterprise risk assessment and outline a repeatable fraud risk assessment method (inherent risk, control effectiveness, residual risk)

Draft fraud risk register entries for four scenarios, each with likelihood, impact, and residual rating rationale

Identify red flags at underwriting (misrepresentation of health, occupation, sum insured, prior claims, beneficiary relationships) and at claims (timing, documentation inconsistencies, provider patterns, staged incidents)

Explain the purpose and limits of data analytics, anomaly detection, and social network analysis in detecting fraud at application and claim stage

Outline the claims investigation lifecycle from referral through evidence gathering, interview, decision, and outcome coding

Describe how fraud indicators feed back into pricing, underwriting rules, and product design

Explain the control objectives and design of preventive controls (identity verification, sanctions and watchlist screening, pre-policy checks, authority limits, segregation of duties)

Explain detective controls (post-claim review, provider audits, duplicate claim matching, whistleblowing channels, reconciliation) and how their effectiveness is tested

Evaluate control gaps in a worked claims scenario and propose proportionate remediation

Describe how control testing results are reported to governance bodies

Summarize the legal and regulatory expectations that shape an insurer's anti-fraud obligations, including reporting duties and cooperation with authorities

Explain the fraud investigation process end to end, including evidence handling, documentation standards, and the rights of the person under investigation

Distinguish internal disciplinary action, civil recovery, and criminal referral, and state the criteria for choosing among them

Describe how recoveries, denials, and voided policies are recorded and how outcomes are communicated to regulators and industry databases

Explain how fraud losses and control costs are quantified and reported, including recovery rates and leakage estimation

Describe the design of fraud awareness training for staff and distributors and how its effectiveness is measured

Outline the requirements for a fraud management information pack (metrics, trends, emerging schemes, near misses) suitable for a risk committee

Identify emerging fraud risks such as digital distribution, synthetic identities, deepfakes in claims evidence, and organized claims farming

Integrate the syllabus into an end-to-end narrative: from risk appetite and assessment through controls, detection, investigation, and reporting

Answer at least 60 practice questions under timed conditions and log every miss by root cause (knowledge gap, misread, or reasoning error)

Rewrite your weakest five topics into concise one-page summaries from memory, then correct them against source material

Rehearse explaining the three-lines-of-defense model and the fraud risk assessment method aloud without notes

Complete two full-length timed mock exams and compare scores against your week-7 baseline

Review every remaining error and close each gap with a targeted source re-read

Condense the entire syllabus into a two-page final recall sheet covering frameworks, control types, investigation steps, and reporting duties

Confirm exam-day logistics and rehearse the recall sheet twice from memory