Combating Insurance Claims Fraud: How to recognize and reduce opportunistic and organized claims fraud
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Overview: Many insurers still believe that it is too expensive to detect fraud, and they simply accept a certain amount of fraud loss as a standard cost of doing business. With the increased focus on customer satisfaction, insurers also are understandably reluctant to stall claims processing to investigate a hunch – or worse, to mistakenly target a legitimate claim and an honest policyholder for investigation. However, insurers that have invested in automated fraud prevention systems have been well rewarded for their decisions.
This white paper explains the technology solutions available to cut your detection time in half. Some fraud-detection techniques screen claims during processing and help prevent improper payments. Others involve retrospective analysis of adjudicated claims and help uncover the activities of fraud rings, internal fraud and leakage. Together, these techniques are powerful deterrents for would-be fraudsters who seek to profit at the expense of insurance companies and their policyholders. Read about how one insurer became aware of at least double the anticipated fraud activity; improved false-positive ratios; and decreased time taken by SIU staff to investigate claims by 50 percent.