The Knowledge Exchange / Risk Management / James D. Ruotolo, Insurance Fraud, SAS

James Ruotolo

James D. Ruotolo, Insurance Fraud, SAS

James Ruotolo, Principal for Insurance Fraud Solutions, Global Fraud and Financial Crimes Practice at SAS, plans, manages and markets SAS® fraud detection solutions. Previously, he was the Director of SIU Strategic Operations for the property and casualty special investigations unit at The Hartford Financial Services Group. Ruotolo also spent several years as manager in Hartford Life’s Group Benefits Division Special Investigations Unit. Prior to Hartford Life, Ruotolo worked with the Fraud Solutions Group at LexisNexis.

James.Ruotolo@sas.com

High-performance analytics: Big technology for big data fraud detection

High-performance analytics

Insurers have access to big, big data – social media interactions, unstructured text, machine-to-machine (M2M) data, and visual media content like photos and videos – but these sources have been overwhelming. They’re too large and change too quickly to be helpful in traditional fraud scoring. Replace overnight batch processing with high-performance analytics.

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Operationalizing a fraud detection solution

James Ruotolo, Insurance Fraud, SAS

With many insurers pursuing an analytical fraud detection solution, a common question arises: Buy a solution or build one internally?

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Partnering for fraud prevention

How Culture Determines Your Appetite for Risk

Some organizations have leveraged statistical software and internal experts to build their own fraud detection models. But building models is only half the battle. This post will review the factors to consider when implementing a fraud detection model.

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Cross-border no-fault fraud

James Ruotolo, Insurance Fraud, SAS

Insurance companies and fraud-fighting agencies in North America are noticing a trend: Fraudsters are now exporting their best practices to our neighbors to the north.The province of Ontario has a mixed no-fault and tort insurance system with superb benefits that fraudsters are capitalizing on. Read this post by James Ruotolo to find out how insures to the north are battling this influx.

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Drawing the line between fraud and abuse in PIP claims

James Ruotolo, Insurance Fraud, SAS

The IRC has identified expensive diagnostic procedures as “major drivers of overall medical costs in auto injury claims.” These drivers can help fuel medical mill scams and make it difficult to differentiate between suspected fraud and suspected medical billing abuse. Scams such as these are putting pressure on legitimate providers to remain competitive. James Ruotolo has some advice for insurers and medical providers.

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The insurance fraud race

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~ Co-authored by Deborah Smallwood, Founder, Strategy Meets Action ~ Although insurers have come a long way in their efforts to detect and prevent fraud, weaknesses remain. It’s estimated that 10 percent of all insurance claims are fraudulent