Briefs

Daily data mining and analytics technologies to red flag outlier policies and claims are key to fraud prevention and efficient claims handling.

By Ellen Melchionni, Insurance & Technology, August 13, 2008

Advancements in technology have made it so that fighting fraud is no longer as closely linked to searching for the proverbial needle in the haystack. The availability of a greater number of tools to insurance companies is changing special investigation units from reactive to proactive organizations.

Industry experts say that companies fully committed to using fraud-fighting technology conduct daily data mining of claims to find red flags that send the claim on a different track where it will receive special scrutiny. One company known for its commitment is Travelers (Hartford), which reports using a myriad of resources that includes:

• Participant identification processes that cross-check claim participants against a list of those previously investigated for suspicious activity;
• Developing picture diagrams of methods of operation for criminal fraud rings;
• Applying statistical algorithms to estimate the probability of fraud in a specific claim based on a known set of past fraudulent claims;
• Detecting outliers by defining "normal" among a peer group, and then detecting abnormal patterns of repeated behavior or detecting a shift in behavior.