Fraud Schemes are complex, dynamic efforts to obtain money or benefits the perpetrator may not have been otherwise entitled to. The people executing these schemes are often times professionals. They have only one job; figure out rip you off for as much as possible in as short a period of time as possible, and hopefully not get caught.
You as a claims adjuster/manager on the other hand, must handle an exhausting case load of legitimate claims, set appropriate reserves, send your 10, 15, or 30 day letters, manage the vendors servicing your claims, meet productivity demands, reduce allocated loss adjustment expenses, indemnify claims appropriately, manage vehicle storage fees, answer the telephone and yes recognize and identify potential fraud when it presents its self. And that's the short list!
Certainly some fraudsters are merely opportunistic, taking advantage of a "once in a life time" opportunity at some fast cash. But many are trained, experienced professionals. Some hold advanced degrees, JD, MD, or DC. Some hold no formal degree but they have been well educated by the school of hard knocks, for instance the body shop owner engaged in billing for repairs either never made or made using substandard parts.
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