SMARTSIU Solution: An Intelligent Claims Validation Systems(ICVS) Product


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Source: Infinilytics
Date: May 2013
Type: Case Study
Rating: (0)

Overview: We recently worked with a regional multi-line Property and Casualty Insurance Carrier who was struggling to leverage their internal data to detect unusual patterns, potential frauds and anomalies within their claims. They estimated it was costing the company roughly $10M in additional paid losses each year due to litigated claims, employer/employee linked fraud rings, unchecked MPNs, smaller but more frequent claims involving body shop, claimant, attorney and adjuster fraud ring including unnecessary payments to preferred providers. This also resulted in higher loss reserving.

While they had processes in place for identifying fraud rings, they were disparate, manual and strenuous processes and would end in “Pay and Never Can Chase” claims due to varying anomalies & patterns in each case. This would invariably lead to adjusters complaining about time delay in closing claims and some genuine claim payment delays leading to customer dissatisfaction. They wanted a solution where anomalies could be identified very early on in the life of a claim, enable SIU’s / Claims team to focus on “Questionable Claims” thereby establishing a cleaner claims validation process.

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