Q&A: Roberto Benassi on detecting, preventing insurance fraud
Poste Assicura SpA detects and prevents insurance claims fraud
Poste Assicura SpA might be a newcomer to the insurance industry, but it has hit the ground running. Started in 2010, the property and casualty insurer capitalizes on Poste Vita Insurance Group's brand reputation and distribution network of 14,000 post offices across Italy to position itself among the industry's top players. To grow and compete at that level, Poste Assicura must limit the economic impact of fraud.
To fuel its ambitions, Poste Assicura turned to SAS® for an accurate, reliable way to detect fraud before claims ever get paid.
We chose SAS because it meets our needs most effectively: easy integration with our information systems, ease of use for any skill level, and flexibility in recognizing and correlating diversified anti-fraud rules.
Portfolio and Claims Supervisor
In the following Q&A, Roberto Benassi, Poste Assicura's Portfolio and Claims Supervisor, shares his insights about preventing insurance fraud and his experience with the SAS Detection and Investigation for Insurance.
What were the reasons for developing the anti-fraud system?
Our mission from the outset was to offer targeted insurance products with a range of proposals, including household damage, fires, civil liability and financial loss. The fraud project should prepare us for a rapidly increasing amount of claims, as suggested by our growth curve. What we are currently able to do in a rough and ready way will require a more systematic and automated approach in the future.
What are the characteristics of fraud?
Whether it's issuing a policy after the harmful event or exaggerating the amount of damage, fraud is not always an isolated phenomenon. Sometimes, one event links to others or involves parties named in other claims. Discovering these hidden correlations is an almost impossible challenge when you rely on a traditional approach.
Therein lies the value of the project. Why did you select SAS®?
After carefully evaluating the situation, we chose SAS because it meets our needs most effectively: easy integration with our information systems, ease of use for any skill level, and flexibility in recognizing and correlating diversified anti-fraud rules.
In your opinion, what are the most innovative aspects?
The system assigns an anti-fraud score to individual claims based on predefined rules. And it alerts the user to possible correlations, namely the persons or entities involved in other claims. One of the strengths of the solution is its ability to perform this cross-analysis almost instantly, effectively and directly with a method of graphical representation that helps the user understand the characteristics of the correlation.
Basically, who are the users?
First of all, the specialists in the anti-fraud unit, an organizational structure with a preventive role. Based on the findings of the system, the anti-fraud unit may decide to initiate a more in-depth study itself or even take it upon itself to manage the claim by going beyond the normal line of processing. In any case, the system transmits the claim score to the investigating agent performing the settlement process, who thus receives a graphical alert of the risk of the case.
Does integration also mean you can access all the documentation on the case?
An essential requirement for us was integration with the document management system, which is entirely in digital format. We were able to ensure that the investigating agent, when examining the case, can interact directly with the electronic claim file in order to gain a complete overview of all aspects of the matter.
What are the expected benefits?
From a strictly economic viewpoint, I expect savings of 5 percent to 10 percent. Implementing a fraud solution indicates how seriously we approach claims settlement, which differentiates us from many competitors. In addition, the prevention of improper payments has a positive effect on the premium rates we can offer to our customers.
Does the solution also affect the decision-making process?
Contrary to the traditional liquidation process, which handles cases in the order presented, we can now assign priority to the investigations and the resulting decisions. Given that the insight, sensitivity and professionalism of the investigating agent are qualities that in many ways are irreplaceable, assigning a score to the claim allows us to identify the events that really merit attention and improve our effectiveness in processing cases.
- Limit the economic impact of fraud linked to business growth.
- Detect and prevent fraud before paying claims.
- Avoid expense of pursuing losses.
- Estimated savings of 5% to 10%.
- Competitive differentiation.
- Lower premium rates for customers.