<![CDATA[Insurance fraud is a latent threat that can disrupt the financial stability of life insurance companies. PT Panin Dai-Ichi Life Medan Branch faces significant challenges in safeguarding against illegitimate claims driven by criminal intent. This study aims to analyze the effectiveness of claim management strategies in mitigating fraud risks in Medan. This study employs a qualitative descriptive case study method. Data gathered through in-depth interviews and documentation were analyzed using a SWOT matrix (IFAS/EFAS) based on Fraud Risk Assessment. The analysis revealed a net IFAS score of +0.48 and an EFAS score of +0.71, positioning the company in Quadrant I (Aggressive Strategy). The primary strength lies in the multi-layered clinical verification by the internal Casemix medical team and strict adherence to prompt payment SOPs. However, challenges persist regarding digital document manipulation and dispute risks due to agent mis-selling. The S-O (Strengths-Opportunities) Strategy is highly recommended, focusing on integrating the claim system with partner hospitals' e-medical records, utilizing AI for anomaly detection, and reinforcing anti-fraud compliance under OJK regulations and Law No. 4 of 2023 on PPSK.]]>
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