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Advanced Analytics in the Battle Against Insurance Fraud

Another Line of Defense

About this paper

As insurance fraud rises, many insurers are looking to improve their fraud defenses by reviewing and enhancing their claims and new business processes, and investing in enhanced technologies. While the biggest challenge fighting fraud is the volume and variety of the fraud itself, other challenges include siloed business units, poor data quality, changing tactics, limited view, manual analysis and false positives.

The first line of defense in detection is and should remain the claims handlers themselves. An analytics approach to fraud detection acts as a second line of defense by making use of the underlying claims and policy data to automatically identify suspicious claims and networks of claims that claims handlers don’t see. But beyond monitoring transactions, an extended approach is needed for monitoring customer behavior across multiple claims and lines of business in order to identify customers that may appear normal on the surface yet operate “below the radar.”

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