TERMS OF REFERENCE (TOR) – Expression of Interest (EOI) – Provision of External Investigation Services

TERMS OF REFERENCE (TOR)
Expression of Interest (EOI)
Provision of External Investigation Services
LNIG Hollard Insure
Closing Date: 16 May 2025

1. Background and Introduction

LNIG Hollard Insure is a leading short-term insurance provider in Lesotho. To strengthen our fraud detection and claims processes, we are inviting Expressions of Interest (EOI) from experienced external investigators. This initiative is aimed at enhancing our investigative capabilities through expert, independent support.

2. Objective of the Assignment

Primary Objective:
To engage qualified external investigators with proven experience in insurance-related fraud investigations to support LNIG Hollard Insure.

Secondary Objectives:

• Enhance fraud detection frameworks
• Support regulatory compliance and internal policy enforcement
• Contribute to process improvement through expert insight

3. Scope of Work

Investigation and Evidence Collection:

• Conduct in-depth investigations into suspicious claims
• Gather relevant documentation: police reports, medical files, CCTV, and interviews
• Engage with claimants, witnesses, and stakeholders

Data Analysis and Reporting:

• Analyze findings to identify inconsistencies or fraud
• Produce comprehensive reports detailing methodologies, evidence, and outcomes

Collaboration and Compliance:

• Coordinate with LNIG Hollard Insure’s claims, legal, and compliance departments
• Liaise with law enforcement when necessary
• Maintain adherence to regulatory and ethical standards

Continuous Improvement:

• Submit periodic insights and recommendations
• Participate in feedback and training sessions

4. Deliverables

• Investigation Reports for each case, including executive summaries and evidence
• Progress Updates on a monthly/quarterly basis
• Presentations for stakeholder review and possible court testimony
• Final Strategic Review summarizing investigations and future recommendations

5. Duration of Engagement

The contract will run for 24 months, with potential renewal based on performance and mutual agreement. EOIs should demonstrate capacity to handle fluctuating case volumes.

6. Eligibility and Minimum Qualifications

Experience and Expertise:

• At least 3 years’ experience in insurance investigations
• Proven track record in managing fraud cases

Certifications (Preferred):

• Certified Fraud Examiner (CFE), Associate in Claims (AIC), or similar

  
  
  

Organizational Capacity:

• Readiness to deploy resources as needed
• Structured approach to investigations and reporting

7. Submission Requirements

Interested parties must submit:

• Cover Letter summarizing experience and interest
• Applicant Profile (company/individual bio, case studies, certifications)
• Technical Proposal detailing approach, tools, and methodology
• Financial Proposal outlining fee structures and payment terms
• References from at least two prior clients

8. Evaluation Criteria

• Relevant Experience: In fraud and insurance investigation
• Methodology and Tools: Quality and robustness of proposed approach
• Cost-Effectiveness: Competitive pricing with clear value
• EOI Compliance: Completeness and clarity of submission
• Past Performance: Positive references and similar project outcomes

9. Submission Details

• Deadline: 16 May 2025
• Submit To: [email protected]
• Email Subject: “EOI Submission – External Investigator Services”
• Inquiries Deadline: 09 May 2025 (email inquiries only)

10. Terms and Conditions

• LNIG Hollard Insure reserves the right to accept or reject any submissions.
• Submission of an EOI does not guarantee engagement or contract.
• All submitted documents will be kept confidential.
• Additional information may be requested as part of the evaluation process.