Why training matters, who needs it, and what effective programs should cover
Anti-fraud training is more than a compliance checkbox, it is one of the most practical ways insurers can strengthen fraud awareness across the organization. Nearly half of the continental United States require some form of anti-fraud training, and in certain states, requirements extend beyond employees to include agents who must receive, or at least be offered, anti-fraud education.
While requirements vary by jurisdiction, several states set specific expectations for frequency, format, and duration. For example, Maryland requires two hours of training at least once every two years. New Jersey requires no less than four and one-half hours of classroom instruction for new personnel and two hours of annual training for existing personnel. These examples underscore the need to keep training programs current, documented, and aligned with each state’s rules.
Who Are Anti-Fraud Personnel?
Anti-fraud responsibilities often extend well beyond a Special Investigation Unit. “Integral anti-fraud personnel” includes insurer personnel whose duties may involve processing, investigating, or litigating matters related to payment or denial of a claim, settlement of a claim, or application for insurance. This may include claims handlers, underwriters, policy handlers, call center staff within claims or policy functions, legal staff, and other employees performing similar duties.
In short, anti-fraud personnel are the people positioned to spot, escalate, document, or respond to potential fraud indicators in the ordinary course of business. Because these teams often encounter suspicious activity first, effective training helps ensure that red flags are recognized early and referred appropriately.
What Training Should Cover
At a minimum, anti-fraud training should give employees a practical understanding of how the insurer’s fraud prevention and referral process works. Core topics should include:
- The function and purpose of the Special Investigation Unit.
- An overview of fraud detection and the referral of suspected insurance fraud to the SIU.
- Identification and recognition of red flags or red flag events.
- Written procedures for identifying, documenting, and referring suspected fraud incidents to the SIU.
- Existing and emerging insurance fraud trends.
- Fraud Division insurance fraud reporting requirements.
- An organization chart depicting the insurer’s SIU, contact telephone numbers and email addresses.
Why This Matters
A well-designed anti-fraud training program helps employees connect daily responsibilities to broader fraud prevention goals. When personnel understand what to look for, how to document concerns, and when to involve the SIU, they become an essential part of the organization’s first line of fraud defense. The result is a more consistent referral process, stronger compliance posture, and greater confidence that potential fraud concerns are being handled promptly and appropriately.
Portions of this article were drafted using AI tools. Content has been verified for accuracy and edited by our team.
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