The menace of fraudulent claims continues to plague the insurance industry. Insurance fraud creates significant financial burden for the insurance carriers as well as other policyholders, due to higher insurance costs. Data analytics is being used to combat this problem for some time now, but it is time to take this solution to the next level.
Fraud techniques evolve to match the solutions to detect and neutralize them. The IASIU (International Association of Special Investigative Units) is an organization formed by insurance fraud investigators to share intelligence and data about prevalent fraud trends, networks, identifying patterns, technology, and people involved in committing frauds.
Insurance Fraud and SIU
The SIU is responsible for the most critical part of fraud mitigation – investigating the potentially fraudulent claims and authenticating them. They also record the tactics, techniques, and technology used by a fraudster for future investigations and to uncover fraud networks and criminal rings. However, their job is not easy, as the fraudsters come up with new schemes every day in their efforts to trick the system. Even with data analytics, they get false positives due to static models that may be built only on business rules.
While fraud in itself is a cost and resource drain, it is also expensive to build the solutions for mitigating fraud. Fraud detection models need to be designed and maintained, and the SIU (special investigative unit) is an integral part of this solution for combating fraud. The anti-fraud efforts payoff for insurers, as reported in 1990, where insurers were able to get $27 for every dollar invested. Although the ROI is pretty good, Opportunities exist today to enhance the ROI further using the latest technologies like AI.
Claims AI Cloud and Fraud Detection
InsurAnalytics.ai was formed by experts who understand the challenges related to insurance fraud, and we are committed to combating insurance fraud in all its avatars. Our AI-powered platform, the “Claims AI Cloud” is equipped to detect potentially fraudulent activity early in the life-cycle of a claim, leading to faster assignment for investigation and better SIU results.
Claims AI Cloud can bring together all the necessary data for processing a claim in a single, harmonized platform. It can collate data from various sources, such as incident data, historical data, adjuster notes, FNOL, claims report, local conditions, and external data. Due to its advanced deep learning capabilities, it can dig deeper in unstructured data sets to find more information and patterns. It can eliminate the problem of false positives and help gather evidence of fraud by providing reasoning for its decisions, thereby increasing the adoption by SIU.
Designed with advanced machine learning algorithms, the Claims AI Cloud continuously learns, and therefore keeps updating the parameters and patterns required for fraud detection. As fraudsters evolve and change, so does the solution to detect them. In fact, with entity resolution and link analysis, the platform can help detect outliers that can directly contribute towards detecting fraud networks and their latest scams.
To see the Claims AI Cloud in action, visit booth no.229 at the IASIU 2019 Seminar & Expo on Insurance Fraud from September 8-11, 2019.
The IASIU 2019 Seminar & Expo on Insurance Fraud is scheduled to be held in Phoenix, Arizona.