A Study On The Management Of The Insurance Fraud Risk Of Group Insurance Channel Of F Insurance Company

With the gradually development of China's economy,the insurance industry is growing rapidly.Accordingly,the market competition is becoming more and more fierce,the premium is getting lower and lower,the cases of insurance fraud is endless,the phenomenon of premium hanging upside down is nothing new now.Due to the limited backup resources input,the lower level of management and control of employees,the insufficiency of methods of risk surveillance,the absence of external support,the situation of the prevention and control of the insurance fraud risk is becoming very severe.F Insurance Company,which ranks the top 10 in domestic market share,is also not immune.The thesis is making a study of the fraud risk management of group insurance of F insurance company according to the ideals elaborated in the<Enterprise Risk Management>(2017 Edition,COSO).The thesis explains the current situation of the risk management of F company,and practical issues of fraud facing the group insurance.The management of fraud risk is fit into the overall risk management structure,but in the course of management,there are many problems,such as the target is not specific,the rights and obligations are not clear,the execution is not in place,the supervision method is insufficient,the incentives are not enough.The core of the risk management of the group insurance of F insurance company,lies in the execution points.The thesis is trying to make recognition of the fraud risk from the aspect of the executive management and technical operation.About the former,interview the experts is used to make a classified recognition of the fraud risk,thus combing the fraud risk indicators of six categories and thirty-two items.About the latter,the risk indicators are distilled according to the status quo of the claim settlement and the investigation of the real cases of the group insurance,altogether combing twenty-five items of risk indicators facing the insurance process,accident process and claim settlement process.At last,the questionnaires method is used to assess the degree of the fraud risk,in order to distill the indicators with higher risk level.Through the risk recognition and assessment,the fraud risk within the operational positions can be prevented before the insurance accidents happen,hence controlling the loss of claims,and by coinsurance and reinsurance,the risk is transferred.In the management of fraud risk,there are many work need to be done,including nurturing the culture of fraud risk management,improving the organizational structure,forging a contingent of talents,enhancing the information supervision and early-warning,strengthening internal communication,acquiring the external support.On the construction of culture,the thesis proposes the culture of compliance management deeply rooted in the employee's heart,the use of all kinds of external platforms of propaganda and education,the establishment of the institution of "award for submission",promoting the knowledge of insurance walking into the enterprises.On the improvement of organizational structure,the structure of the fraud risk is combed again,clarifying the responsibilities of all working positions.On the construction of the contingent of talents,the thesis proposes the establishment of the training system of employees,the attractive institution of incentives,the technique-rank system equivalent to the administrative rank,and the marketing team with the ability to prevent the fraud risk and provide basic investigation,bringing the loss ratios and the prevention and control of fraud risk into the appraisals of the marketing team;in the aspect of achieving the external support,hoping to acquiring the updated and useful information,by deepening the cooperation with the IAC,hospitals,social security centers,public securities,judicial organization.The research obj ective is to provide some reference to F insurance company and other companies of the insurance industry,hoping to overall enhancing the awareness of risk prevention,hence achieving the sustainable development.