Title: How to control vendor service to avoid fraud in insurance sector

Authors: Filipa Morais; Leandro Pereira; Álvaro Dias; Rui Gonçalves; Renato Lopes da Costa

Addresses: ISCTE – Instituto Universitário de Lisboa, Lisbon, Portugal ' BRU – Business Research Unit, ISCTE – Instituto Universitário de Lisboa, Lisbon, Portugal ' Universidade Lusófona de Humanidades e Tecnologias, ISCTE – Instituto Universitário de Lisboa, Lisbon, Portugal ' PIAGET Almada, Almada, Portugal ' BRU-IUL – Business Research Unit, ISCTE – Instituto Universitário de Lisboa, Lisbon, Portugal

Abstract: The difficulty in controlling the quality of services provided by external providers, in the settlement of multi-risk claims, increases the risk of fraud and constitutes an obstacle for insurance companies. The methodology used seeks to understand the evolution of quality control of external providers; to identify the causes of the incapacity to implement adequate controls and the main impacts of this constraint; and to define the best solution to solve the problem and the benefits for the company. Although there is a greater concern, controls are still insufficient, which may create economic and financial losses, negatively impact customer satisfaction and weaken the company's image. The lack of sensitivity to fraud and the misuse of resources condition adequate quality control. Audits and the parameterisation and automation of controls offer greater robustness to the company, increase security with customers and control financial waste.

Keywords: external fraud; fraud in the insurance sector; fraud prevention; detection.

DOI: 10.1504/IJSOM.2024.140426

International Journal of Services and Operations Management, 2024 Vol.48 No.4, pp.511 - 542

Received: 10 Jan 2022
Accepted: 01 Jul 2022
Published online: 08 Aug 2024 *

Full-text access for editors Full-text access for subscribers Purchase this article Comment on this article