Jane Menin Bagley, Fuzion’s SVP, General Counsel and Chief Fraud Officer, was featured on the Insurance Sync podcast hosted by Bobbie Shrivastav, Co-Founder and COO of Benekiva, and Laurel Jordan, Insurance TPA Officer at Sutherland. The duo created the weekly podcast to explore the ever-evolving insurance and technology landscape and its latest trends and challenges through interviews with industry thought leaders.

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During the half-hour interview, Bagley, who has 30 years of experience in the long-term care insurance (LTCi) industry, shared that insurance fraud, waste and abuse (“FWA”) is a $300 billion issue for insurance carriers and policyholders. She explained the critical importance of ensuring that people, processes, and technology work in an integrated fashion in order to successfully identify, investigate, and resolve FWA issues. Jane described her experiences of integrating Legal and Operations departments to enhance FWA program effectiveness.

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Jane stressed that technology used to identify FWA can be very effective in generating data outputs.  Unfortunately, carriers often don’t have the resources or experience to effectively triage or analyze data and the impact it has on FWA. This often results in missed opportunities to investigate and successfully resolve FWA issues.

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“Fraud, waste, and abuse requires special handling.  It is not your standard operation. It’s something that gets bumped out for further handling. You really need the human factor, the human intelligence, to work closely with the technology,” Bagley emphasized.

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This is where Fuzion’s expertise comes into play. Fuzion partners with its FWA clients to provide them with a variety of tools for their FWA toolbelt and works with many clients who see value in outsourcing this specialized function. “Fuzion’s carrier clients are diverse and in different stages of their FWA programs, some with no programs in place and others with sophisticated programs that need help filling in gaps,” Bagley said. Additional discussion between Bagley, Shrivastav, and Jordan accentuated the importance of creating a culture of awareness including conducting regular and interactive training is where a solid program starts, and a successful program can be built methodically and effectively over time.  

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Click here to listen to the interview on Spotify.