Terms Of Reference For Expression Of Interest
For The Provision Of External Investigation Services
1. Background and Introduction
LNIG Hollard Insure is a leading provider of short-term insurance products. In order to strengthen our fraud detection and claims investigation processes, we are seeking qualified external investigators to conduct thorough investigations into potentially fraudulent claims and provide expert analysis and reporting. This Terms of Reference (ToR) outlines the requirements and process for interested candidates or firms to submit their Expression of Interest (EOI).
2. Objectives
Primary Objective:
To identify and engage with external investigators who have a proven track record in insurance investigations, particularly within the insurance sector, with the aim of supporting LNIG Hollard Insure in:
Secondary Objectives:
- Enhance current fraud detection frameworks.
- Ensure compliance with regulatory requirements and internal policies.
- Foster continuous improvement in investigation processes through external expert insights.
3. Scope of Work
Investigation and Evidence Collection:
- Conduct comprehensive investigations on suspicious or flagged insurance claims.
- Collect all pertinent evidence including police reports, medical records, surveillance footage, and witness statements.
- Schedule and conduct interviews with claimants, witnesses, and other relevant parties.
Data Analysis and Reporting:
- Analyze collected data to identify inconsistencies and potential fraud indicators.
- Prepare clear, concise, and detailed investigation reports outlining methodologies, findings, and recommendations.
Collaboration and Compliance:
- Work closely with LNIG Hollard Insure’s internal departments (claims, legal, compliance) and, when necessary, liaise with law enforcement.
- Ensure investigations adhere to regulatory standards, internal policies, and ethical guidelines.
Continuous Improvement:
- Provide periodic updates and recommendations on improving investigation processes.
- Engage in feedback sessions and training sessions as required by LNIG Hollard Insure.
4. Deliverables
- Investigation Reports: Detailed written reports for each investigation including executive summaries, evidence logs, analysis, and actionable recommendations.
- Regular Progress Updates: Monthly or quarterly progress reports outlining investigations conducted, outcomes, and any emerging fraud trends.
- Ad-Hoc Presentations: Participation in review meetings with relevant stakeholders and, where necessary, providing expert testimony in legal proceedings.
- Final Strategic Review: A comprehensive review at the end of the engagement period summarizing all cases handled and recommending improvements to the fraud detection process.
5. Duration of Engagement
- The initial engagement period will be for 24 months, with the possibility of extension subject to performance, evolving needs, and mutual agreement.
- The EOI should indicate capacity to scale or adjust resources based on fluctuating case volumes.
6. Eligibility and Minimum Qualification Criteria
Interested parties must meet the following criteria:
Experience and Expertise:
- Minimum of 3 years’ experience in investigating claims, with specific reference to the insurance industry.
- Demonstrable experience in fraud detection and managing complex investigative cases.
Certifications and Licensing:
- Possession of industry-recognized certifications (e.g., Certified Fraud Examiner (CFE), Associate in Claims (AIC)) is preferred.
Organizational Capabilities:
- Ability to mobilize resources rapidly for ad-hoc investigations.
- A structured, methodical approach to case management and reporting.
7. Submission Requirements
Interested applicants are requested to submit the following:
- Letter of Interest: A cover letter summarizing relevant experience, capabilities, and interest in the engagement.
- Applicant Profile: Detailed information about the individual or firm, including:
- Company/individual background
- Relevant experience and case studies (if applicable)
- Copies of relevant certifications and licenses
- Technical Proposal: An outline of the investigative methodology, tools, and processes to be used in fulfilling the scope of work.
- Financial Proposal: A summary of pricing, including fee structures, payment milestones, and any additional costs.
- References: Contact details for at least two references from previous assignments of a similar nature.
8. Evaluation and Selection Criteria
Submissions will be evaluated based on the following:
- Experience and Expertise: Proven track record in insurance investigation and fraud detection.
- Methodology and Tools: The robustness of the proposed investigative approach and familiarity with modern investigative tools.
- Cost Effectiveness: Overall value for money in the financial proposal.
- Compliance with EOI Requirements: Completeness and clarity of the submitted EOI documents.
- References and Past Performance: Positive feedback from previous engagements and relevant case studies.
9. Submission Guidelines
- Deadline for Submission: All responses must be received by 16 May 2025. Late submissions may not be considered.
- Submission Method: All documents should be submitted in electronic format, sent to:
Email: [email protected]
Subject Line: “EOI Submission – External Investigator Services” - Inquiries: Any inquiries regarding this EOI must be submitted in writing via email to [email protected] by 09 May 2025. Responses will be provided in writing to all registered applicants.
10. Terms and Conditions
- LNIG Hollard Insure reserves the right to accept or reject any or all EOIs received in response to this announcement.
- The submission of an EOI does not bind LNIG Hollard Insure to award a contract or to pay any costs incurred in the preparation of the EOI.
- All information submitted as part of the EOI will be treated as confidential and used solely for the purpose described in this document.
- LNIG Hollard Insure may publish an award notice or request additional information should it deem necessary.