SMARTSIU Solution: An Intelligent Claims Validation Systems(ICVS) Product [ Source: Infinilytics ]

May 2013- 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 ...

Using Data Mining To Detect Insurance Fraud [ Source: IBM ]

October 2011- Insurers lose millions each year through fraudulent claims. Learn how leading insurance companies are using data mining techniques to target claims with the greatest likelihood of adjustment, improving audit accuracy and saving time and resources. Read this paper to learn how to combine powerful analytical techniques with your existing fraud detection and prevention efforts; build models based on previously audited claims and use them to identify potentially fraudulent future claims; ensure adjusters focus on claims ...

Combating Insurance Claims Fraud: How to recognize and reduce opportunistic and organized claims fraud [ Source: SAS ]

September 2009- 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 ...

Guidelines for Claims Management Systems Selection [ Source: Systema Software ]

January 2009- Selecting a new claims system can be an intimidating task due to the risks involved in going with the wrong choice. The complexity of the evaluation process requires an understanding of technology, change management, licensing and support options among others. The purpose of this white paper is to help you simplify this effort by focusing on what really matters and avoiding getting caught up in the technical and vendor jargon.

Anti-Money Laundering: Helping Life Insurance Companies Mitigate Regulatory Risk [ Source: SAS ]

June 2008- The U.S. Department of Treasury released in October 2005 the final ruling that life insurance and annuity companies must implement money laundering-prevention programs and comply with Suspicious Activity Report (SAR) guidelines by May 2006. This white paper takes a brief look at ways SAS Anti-Money Laundering is designed to help these companies comply with regulations. You will learn about SAS' ability to detect a variety of suspicious activities. Anti-Money Laundering helps life insurance and annuity companies ...

The State of Claims Fraud Detection and Prevention [ Source: SAS ]

October 2007- This document reveals the findings of a May 2007 research study conducted by Insurance and Technology magazine on claims fraud detection and prevention, in which 102 readers answered an online survey by CMP Research.  

MMA Uses Advances to Save Fraudulent Claims Payouts Five Times Greater than the Service Costs [ Source: CSC ]

March 2005- UK general insurer, MMA, wanted better measures for combating claims fraud. It was prompted to seek specialist help in view of industry-average estimates of 10% fraud in motor claims and 15% in household claims. MMA opted for CSC's Advances, a comprehensive solution available as a hosted Web service, which saved the insurer five times as much in claims leakage as the company paid for the service, increased the number of claims declined or withdrawn by 63% and reduced ...

Challenges in fighting insurance fraud and the value of Special Investigative Unit Outsourcing [ Source: CGI ]

October 2004- While some perceive insurance fraud as a "victimless" crime, its impact on society is far reaching, costing not only insurers but also consumers billions of dollars every year. According to research firm Conning & Company, insurance fraud cost consumers $96.2 billion in higher premiums in 1999 and more than $530 million in higher prices for good and services.2 It estimates that all types of insurance fraud cost the average American household nearly $5,000 a year in the form of higher ...

ILOG and SPSS - Accurate, actionable and auditable solutions [ Source: ILOG, Inc ]

November 2007- The ILOG-SPSS solution enables private companies and public-sector agencies to screen large data volumes, target patterns and profiles, and automate decisions and responses. It supports critical business processes that include background checks, fraud detection, pricing and risk scoring, customer retention and fraud detection as well as internal fraud prevention.