Definitions
Any intentional or deliberate act to deprive another of property or money by guile, deception or other unfair means.
What is Fraud
In 2022 ATO related clues tips were shifted to be monitored by the Profiling Analysts consisting of these three team members
Who are C.C. , H.O. & G.S
Launch of the ________ consolidated 7 lead sources into one, reducing duplication of work and saving time.
What is the MI Leads Tool
Sunlife members / business partners will email this address to report suspicious activities.
What is the Clues in box
Process where insurance providers stop paying claims from specific facilities / providers due to fraudulent activity.
What is delisting
The fraudulent acquisition and use of a person's private identifying information, usually for financial gain.
What is Identity Theft
FRM’s dedicated Account Takeover Investigator.
Who is J.P.
FRM uses _________to create graphic visualizations of client / member behaviour to develop predictive models and reporting.
What is Tableau
Post-payment / random / selected / targeted are all types of ____ reviewed by Analysts.
What are Audits
Scheme where 2 or more people work together to mutually benefit from fraudulent activity.
What is collusion
This is a fraudulent system of making money based on recruiting an ever-increasing number of "investors".
What is a Pyramid Scam
This Investigator holds down the fort on the Pharmacy Profiling team, deep diving into Pharmacy claiming behaviours looking for costly shenanigans .
Who is J.P
The website where we have consolidated all knowledge articles for each business unit.
What is Athena
We run these to verify ownership in businesses to assist in our investigations.
What is a Corporate search
Member & MC Investigators often notify ___________ about confirmed fraud or collusion in an effort to mitigate future fraud.
What is the Plan Sponsor
Is a type of fraud where cyber-criminals use social engineering tactics to trick individuals into clicking on malicious links/attachments.
What is Phishing
These 2 teams create Output reports to share their investigative findings with Sun Life Business partners.
What are Disability and Advisor Teams
Employees and leaders are encouraged to share written recognition and celebrate their colleagues’ success on the platform.
What is Applause
To be sent to a member or provider to advise we have sent an email from our secure site.
What is a SPAM notification e-mail
A good Interview can result in a formal statement from a member or provider admitting false claims or documents were submitted, also known as a ____________.
What is a Confession
These scams were responsible for the second highest amount of fraud-related dollar loss in 2022.
What is a Romance Scam
Not only is this person the leader of IST, he has also serenaded FRM on multiple occasions with his sultry voice and soulful musicality.
Who is CD
________ is used to find a provider’s specialty and their license number.
What is Spector
Warnings are added on file if you have reinstated web access but feel further ___________ is required.
What is monitoring
Someone hired to pose as a customer to report on the quality of the service received, billing practices and items received.
What is a secret shopper