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The State of Insurance Fraud Technology – SAS Research Report

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Article Synopsis :

Whether internal or external, fraud hits the bottom line of every insurance company. Unsurprisingly, nearly 75% of insurers have fully integrated technology in their anti-fraud systems. In 2016, the Coalition Against Insurance Fraud, in partnership with SAS, conducted a survey-based study to better understand how insurers are using technology to detect and prevent losses. The 86 participating companies represent a significant share of the P&C market. The study is a follow-up to similar studies conducted in 2012 and 2014, which enables comparisons over time on two questions:

 The Digital Insurer reviews SAS Institute’s Report on The State of Insurance Fraud Technology

The use of technology to combat fraud is on the rise, with 76% of insurers focusing tech investments on claims fraud  

  • To what degree are insurers succeeding with technology?
  • What are their challenges, results and future plans?

According to the survey, cases of insurance fraud are on the rise and, as stated, close to 75% of insurers have fully integrated technology into their anti-fraud systems with a majority reporting a financial justification of their anti-fraud investments.

Other key findings from the report include:

  1. The percentage of insurers using technology to detect suspect claims has risen from 65% to 76% in last four years.
  2. More than 50% of respondents have started using predictive modelling.
  3. 70% of respondents say technology accounts for more than 10% of fraud referrals while 6% say they receive more than 60% of referrals through technology.
  4. The two biggest challenges faced by insurers to expand their fraud detection programs is the lack of IT infrastructure and relevant data.
  5. One-third of special investigative unit (SIU) directors expect their IT budgets to increase in 2017. Topping the agenda is predictive modelling and link analysis/social-media programs.
  6. The most popular technology deployed is automated red flags/business rules, used by 90% of insurers.
  7. Internal data and public sources are the largest data sources for feeding anti-fraud technology systems. Social media data use is on the rapid rise.
  8. Using tech to uncover internal fraud has plateaued at 29 percent. Insurers using anti-money laundering software fell from 24 percent to nine percent over the last two years. The decline may stem from the small sample size for that question in 2014.
  9. Cyber fraud continues to be a growing issue for insurer anti-fraud departments. Nearly one of five say they use technology to combat this growing threat.

For all the positives delivered by anti-fraud software, the two hindrances to wider adaption include scarcity or resources – both technical and financial, and excessive false positives. SIU directors say their units spend far too much time investigating cases that are not legitimate fraud reports.

64% of respondents maintain their anti-fraud systems in-house, the rest outsource. Anti-fraud technologies have the greatest impact on fraud dealing with personal auto, organized rings and medical providers.

In conclusion, the report asserts employing technology to detect fraud at an early stage is key to reducing fraudulent cases. Early detection of fraud is imperative to lower claim costs, more accurate pricing, and lower premiums for policy holders. Deployment of the right tools and technologies to reduce fraud frequency helps insurers and insurance customers alike.

Link to Full Article:: click here

Digital Insurer's Comments

As insurers know, fraud schemes shift. Software solutions have advanced to where they can “learn” from experience and continuously improve at identifying new patterns of fraud. The more-intelligent the tools, the greater chance of detecting fraud in the early stages, and even predicting potential areas of fraud before criminals uncover the opportunity.

But it’s not all about the technology. The goal is to develop an automated fraud detection ecosystem, wherein knowledgeable and well-trained people utilize digital tools to their highest degree. Today almost 80% of fraud detection is aimed at claims fraud. It’s not unreasonable to think the skills and knowledge gained mining and synthesizing various types of internal and external data will find valuable applications in underwriting and new product development. SIUs saving money on claims today, may expand that expertise to help grow revenue tomorrow.

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