For Insurers

The Highest Level of Insurance Solutions, Service, and Support

Building a strong partnership to support your Fraud, Waste, and Abuse program

Taking a proactive stance in managing Fraud, Waste, and Abuse (“FWA”) does more than enhance block performance — it actively protects your organization and policyholders. There’s no one-size-fits-all solution. That’s why our FWA programs are fully customizable to meet your unique needs, offering:

• FWA Training
• FWA Capability Assessment
• FWA Investigation
• FWA Program Consulting & Management

Whatever your FWA needs, Fuzion’s customized approach can elevate your program’s effectiveness. From prevention to investigations to successful, case-file resolution, we’re passionate about mitigating FWA and bring years of experience to the challenge. Our team integrates technology with experienced CFE credentialed professionals, and has achieved remarkable results. As an example, one client saved over $10 million in the beginning stages of our FWA partnership.

Take a proactive approach now to FWA mitigation. It’s a reliable path to enhancing the operational and financial performance of your block of business.

$308.6 billion
According to the Coalition Against Insurance Fraud, FWA cost carriers and policyholders approximately $308.6 billion annually.
FWA Training
According to the Coalition Against Insurance Fraud, FWA cost carriers and policyholders approximately $308.6 billion annually. That is why FWA training is critically important. Our in-person or remote FWA awareness training is specially designed for anyone responsible for generating case file referrals, including claims examiners, underwriters, managers, and call center representatives. Our engaging training sessions will educate your employees on the importance of mitigating FWA, and their role in the process. Participants will learn tactics, best practices, and processes to effectively identify and address FWA. Reviews of actual case files and emerging trends will empower your team to make a significant impact in protecting policyholders and your organization.
FWA Capability Assessment
Focusing on people, processes, and technology, our FWA Capability Assessment delivers valuable insights about your program, identifying strength and opportunities for improvement, while establishing actionable goals tailored to your needs. With Fuzion as your partner, you’ll obtain a unique industry perspective that enhances risk management, and fills gaps in your processes. Our customized approach ensures we meet you where you are, providing the tools and expertise to elevate your program’s success. You can trust Fuzion to guide you toward positive FWA mitigation outcomes with our Capability Assessment.
FWA Investigation
Fuzion investigators can manage the entire investigation process, from initial case referral through resolution. We offer comprehensive social media and open-source investigations, vendor coordination and oversight, policyholder and provider interviews, and strategic recommendations — all leading to successful resolutions. Our certified fraud examiners and FWA experts provide hands-on management, allowing you to focus on your core responsibilities, while we protect your business and policyholders. We work closely with our clients based on shared objectives and desired outcomes, and pride ourselves on our collaborative approach. Successful resolutions may include repayment of unsubstantiated claims, improved claims controls, and recommended legal actions. For proactive, best-in-class solutions that ensure compliance with regulatory requirements, Fuzion is the ideal partner to advance your fraud mitigation program.
FWA Program Consulting & Management
What sets us apart is our commitment to partnership; we don’t see FWA program development as a one-time task, but as an ongoing collaboration that evolves with your needs and continues throughout the program. Our expert investigators and managers will work closely with you, developing customized case management tools, specific insurance block analytic models, and actionable strategies to achieve the optimum FWA operating model. Knowing that Fuzion is your FWA program partner, you can confidently focus on other core operations. We understand every client has unique circumstances. That is why a successful FWA program must be tailored to a client’s needs. FWA finds its way through gaps in training, processing, and procedures. Fuzion identifies and corrects these vulnerabilities, protecting your policyholders and your revenue from a major source of loss.
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Proud of our top-tier Fraud, Waste, and Abuse solutions, partnering with insurers to resolve FWA and positively impacting their policyholders and business outcomes.

Jane Menin Bagley

General Counsel & Chief Fraud Officer

Making your priorities our mission

Fuzion’s services are tailored to your needs, so you can be sure you will receive the greatest benefit from our partnership and the services you choose. Whether you require:

• Targeted Claims Audits
• Comprehensive Claims Review
• Claims Process Improvement, or
• Claims Eligibility Determination Support
…we’ll provide a solution that will address your priorities.

We have deep expertise in claims eligibility determination and identifying the root causes of claim-handling errors. Once errors are identified, we’ll provide effective solutions for remediation and prevention. We believe quality resides in the details. Our high level of customization, and proprietary best practices, ensure accuracy and quality at every level of service.

Targeted Claims Audits
Audits should accomplish more than pinpointing specific findings — they should also enhance your operations. Fuzion’s Targeted Claims Audits do both. Our Targeted Claims Audits are designed to match your needs and priorities. We focus on specific selection criteria rather than randomly selected claim files to deliver a tailored report that allows you to deploy the most appropriate actions. Our audits meet the highest industry standards. And our collaborative approach ensures that our Targeted Claims Audits adhere to your unique requirements. Ongoing communication and end-of-audit discussion are key components to ensuring you receive the most from our insights and findings.
Comprehensive Claims Review
Claims adjudication, processing, and payment includes many functions that all need to work cohesively to maximize your company’s operational performance. Fuzion’s Comprehensive Claims Review provides a penetrating look at the claim life cycle and includes an audit of a random sample of claim files defined by you. Our expert team will meticulously examine your workflows, processes, technology, and performance metrics to identify strengths, weaknesses, and opportunities. Working within your defined scope, we’ll closely review your claim files to ensure appropriate benefit eligibility decisions, accuracy of payments, and compliance with policies. Close collaboration with our partners sets us apart, while ensuring that business process improvement opportunities are defined, identified, evaluated, and ready for implementation.
Claims Process Improvement
There’s always room for improvement when it comes to operations. Fuzion’s Targeted Claims Audit or Comprehensive Claims Review will reveal areas that need refinement. We’ll work with you to improve your claims process by developing actionable plans. We also offer project management support to help implement recommended enhancements. By leveraging Fuzion’s extensive block management experience, you can expect greater efficiency and cost-savings across your entire enterprise.
Claims Eligibility Determination
Determining the eligibility of a claim is not a simple process. To make the right call, it requires good judgement, knowledge in interpreting policy language, and in many instances extensive claims adjudication experience. That is why Fuzion provides carriers with a proven claims eligibility determination service that can function as an extension of your internal team. Moreover, it can take the pressure off finding and training the right people, who may require months to become proficient at this important skill.
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I am honored to be part of a team that puts our clients and their policyholders first, ensuring their needs are always our top priority.

Julie Peterson

VP of Operations

Flexible support for your communication needs

We understand that insurers often face communication challenges that can’t be solved with off-the-shelf solutions or existing internal resources.

That’s why we offer tailored support across a wide range of communication needs, including:

Communications Planning & Implementation
Policyholder Communications Improvement
Policyholder Engagement Consulting
Premium/Benefit Modification & Communications

We understand insurers may have special communication needs that cannot be met by off-the-shelf solutions or their existing resources. That is why we offer solutions and tailored support in a wide variety of communication areas. If you have a communication challenge that demands a creative and flexible approach beyond business-as-usual, don’t hesitate to contact us to help you strategize and develop the right materials.

Communications Planning & Implementation
Effective customer communications is a crucial aspect in policyholder satisfaction. Fuzion can help you build and execute a successful communication plan that addresses all your customer needs, from policyholder engagement to claims letters to periodic updates on policyholder benefit coverage.
Policyholder Communications Improvement
Clients rely on Fuzion’s expertise in the review, design, and authoring of letters, forms, educational materials, and online content for a variety of audiences that include policyholders, designees, beneficiaries, agents, and more.
Policyholder Engagement Consulting
Finding ways to keep policyholders engaged can dramatically boost satisfaction. Our engagement consulting services include proactive outreach, targeted educational communications, satisfaction surveys, newsletters, and benefit statement mailings, all aimed at ensuring the highest levels of policyholder support.
Reliable
Award-winning policyholder communication that drives trust
Premium/Benefit Modification & Communications
Policyholders’ perceptions and attitudes are crucial to your reputation, particularly during premium and benefit changes, routine operations, or state interventions, should that situation ever arise. Fuzion’s communication management services deliver complex premium, benefit, and policy information clearly and conveniently for policyholders, along with effective follow-up communication. We can personalize communications with relevant policyholder details and even create educational videos. Our approach has garnered numerous awards. We invite you to discover why.
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Applying my passion of learning about client needs and supporting initiatives to improve their policyholder engagement is an honor and
such a pleasure.

Debbie Maas

SVP Communications and Client Engagement

Let’s discuss our solutions for Insurers

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Events

2025 Long-Term Care International Forum

October 21, 2025

Fuzion places a high priority on and values our ...

Events

IAIR 2025 Technical Development Series Workshop

October 21, 2025

Robert Loren Robinson, Fuzion’s President, will attend ...

Events

International Claim Association 2025 Annual Education Conference

September 28, 2025

Fuzion is proud to participate in the ICA Conference ...

The Highest Level of Insurance Solutions, Service, and Support

Building a strong partnership to support your Fraud, Waste, and Abuse program

$308.6 billion

Making your priorities our mission

Flexible support for your communication needs

Reliable

Let’s discuss our solutions for Insurers

Explore solutions
for Receiverships

2025 Long-Term Care International Forum

IAIR 2025 Technical Development Series Workshop

International Claim Association 2025 Annual Education Conference

News and Insights

Sign up for email updates

The Highest Level of Insurance Solutions, Service, and Support

Building a strong partnership to support your Fraud, Waste, and Abuse program

$308.6 billion

Reliable

Let’s discuss our solutions for Insurers

Explore solutions for Receiverships

2025 Long-Term Care International Forum

IAIR 2025 Technical Development Series Workshop

International Claim Association 2025 Annual Education Conference

News and Insights

Explore solutions
for Receiverships