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Insurers, what steps are you taking to prevent fraud?

by The Data Company, 21 February 2023 

Connect, Visualise, and Analyse Data to Identify and Stop Fraud!

Insurers, what steps are you taking to prevent fraud? Is it enough?

Detecting and preventing fraud is a global challenge for insurers. Fighting fraud is often reactive rather than proactive, meaning insurers often lose out. To fight fraud, insurers need data analysis tools to make fraud reviews, detection, and actionable insights possible. 

Unfortunately, all too often, insurers face challenges in implementing and utilising such tools. The challenge of unifying data from multiple sources and structures with the complexities of security access greatly restricts their ability to effectively combat fraud. Further opportunities such as fraud analysis and automated actions are completely missed.

Why do we anticipate there will be an increase in fraud?

Well, history tells us that in times of severe economic stress and financial pressure, the levels of fraudulent activity increase.

We know all too well that all that would-be fraudsters require is an opportunity, and they will target weak or poor processes in your front-line defences.

 We are reminded of the fraud equation:

Fraud propensity  =   Inclination + Opportunity / Resitance

And let’s not forget this is no longer just a back-office challenge; fraud can be evident throughout the policy and claim lifecycles and across any product line.

Technology: Intelligently Prevent Fraud

Internal fraud systems are a big part of fraud detection. Take a look at DataWalk, our “Next Generation” fraud detection and investigation solution that is already being used by leading insurers, law enforcement agencies, and government agencies around the world.

DataWalk applies AI, Machine Learning, and flexible rules-based technology against both internal and external data sources to assess the likelihood of a case being fraudulent and produces a single “adverse fraud score,” which can be applied to both automate “high-risk’ referrals for investigation or fast-track “low-risk” claims for straight-through processing.

Where deployed, the solution has significantly reduced the false positive rate to (<10%) across a variety of insurance product lines. Add to this the ability to use the system as an ad-hoc investigation tool as well as a platform to ingest data from various sources to create a single customer view, and its combined capability can reduce the need for multiple solutions.

  • Each client’s needs are taken into account when setting up the system, and you can be up and running (and self-sufficient) in a matter of weeks.
  • The DataWalk platform provides a full-circle forensic processing, detection, and analysis solution, passing on the advantages of AI to insurers.
  • This platform provides a single view of all relevant data and subsequent analysis, empowering claims teams and investigations to intelligently prevent fraud.
  • This platform helps insurers overcome the challenges of implementing new solutions and quickly optimise processes and automation, thereby resulting in huge cost savings.
  • ROI is achieved rapidly.

What action should you be taking?

A good starting point would be to consider your usual risk and compliance review process. Take a look at your systems controls, daily practices, and processes to find new risks (especially internal fraud risks with a remote workforce), and review and keep up with the delivery of fraud training to all staff to make sure your teams are aware of the changing threats.

Call us today and we’ll give you a free demo and consultation to show you how you can also stop fraud.

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