Unique SIU Services Can Provide Cost Savings.

Every so often, someone brings a new approach or enhancement to an already powerful industry. By combining two traditionally separate skill sets (claims adjusting and insurance fraud investigations) to create new services for the insurance industry, a Southern California-based company has done just that.

For the vast majority of organizations within the insurance industry today, there is a great deal of frustration when it comes to meeting government-mandated SIU requirements, while keeping costs down and remaining profitable.

Law enforcement officials have long expressed the need for effective SIU units in place at insurance organizations. Moses Gomez, a manager of criminal investigations in Southern California for one of the busiest law enforcement agencies specifically geared to insurance fraud investigations said, "Not only does the company who sells insurance policies need to understand who they are writing for -- they need to know the potential losses that may arise from the activities of their policy holders. Through effective training and adjusting, an effective in-house SIU or third party organization can help insurance companies stop the problems before they start."

"After insurance companies write their policies," continued Gomez, "it is imperative that their next consideration be the effectiveness of their (or their third party administrator's) SIU capabilities. If you are managing an insurance organization of any size, it's important that your operation meet a number of criteria."

Gomez outlines those essential criteria as follows:

* A well trained claims department who are the first line of defense when uncovering fraudulent activities and when to report the same to the Special Investigations Unit.

* A well organized Special Investigations Unit who can identify training needs for claims personnel, when suspected fraud claims need to transition from the claims department to the SIU.

* An experienced SIU who can continue the inquiry or investigation and provide the necessary report summaries and the ability to convey the need for their investigation to receive attention from law enforcement.

* A claims department that effectively interacts with the SIU on a regular basis for training and updating information as it relates to suspected fraudulent claims.

"These criteria sound straightforward," said Gomez, "but there are very few companies that understand the need and the importance of good claims handling as it relates to suspected fraud and the SIU follow-up. Everyone loses when the relationship between claims management and SIU is not strong. If any of those elements are missing or ineffective as they currently stand, it's time to reevaluate."

Southern California based Ron Reza is attempting to address the need for these elements head-on. Be it fraud investigations, claim adjusting, training, toss analysis, or across-the-board SIU program development, Reza has designed a solution that he believes can assist in the handling of claim files from the inception of the claim to the final disposition.

Reza launched ProLine Insurance Services earlier this year with the notion that a fully comprehensive, outsourced SIU consulting service could bring the insurance industry enhanced efficiency SIU support at tremendous cost savings. Utilizing a unique blend of investigative and adjusting experience, Reza launched ProLine to offer insurance companies and self-insured organizations an outsourced, in-compliance Special Investigations Unit at a fraction of in-house SIU department costs.

What makes Reza a unique practitioner in the SIU field is the fact that he has worked both sides of the industry fence: compiling valuable experience in state-of-the-industry investigations and claims adjusting.

Reza laid the foundation for ProLine with his experience and thorough knowledge of adjusting and claims handling. He served as a senior adjuster for one of the largest auto insurance companies in Southern California. His liability experience extends from his background as a claim adjuster to his work testifying before the grand jury and in superior and municipal court as a criminal investigator specializing in fraud. Recently, Reza oversaw all facets of the California SIU operation of a national property casualty carrier.

Reza is also a law-enforcement trained criminal investigator with more than six years experience investigating insurance fraud and financial crimes for the Department of Insurance and the Department of Corporations. He has performed undercover operations, interrogations, complex financial investigations and training for law enforcement agencies to identify organized insurance fraud activities.

Reza also brings to ProLine his role as a studied and effective trainer and motivator on all things "SIU." As a result, he is able to extend his knowledge to client staffers with powerful results. Because Reza maintains his fire and casualty agent/broker license, he is able to clearly understand the carrier's objectives.

Insurance industry professionals agree that there is a need for comprehensive, outsourced help meeting SIU goals.

"For our industry, a way to place claims and SIU on the same page has been a long time coming," said Trinh Hinson, assistant vice president at a property casualty company based in New York doing business in California. "Ron Reza's concept is particularly intriguing due to his unique background. Because of his experience, Ron has a deep understanding of the entire claims process. He also happens to be one of the most professional SIU investigators I've worked with. That's an unbeatable combination that would be invaluable to any organization in that Ron refuses to overinvestigate. He understands that that when it comes to claims, the real goal is to pay fairly and efficiently, but only for the claims that are owed."

With his ProLine Insurance Services concept, Ron Reza has designed a potential solution for an industry need -- providing clients (be they full-service insurance companies or self-insured entities) with an overheadfree, fully outsourced SIU department commissioned to meet government regulations and combat fraud.