Even within P&C Commercial lines, Workers’ Compensation insurance is a unique niche. The stakes, if not higher, are at least different when you’re insuring not buildings and vehicles but human beings. People. Can you imagine a more unpredictable risk, or one that contributes in more ways to your success? ... Read More >
The three main use cases FRISS supports are: FNOL Fraud Detection – detects fraud during creation of the claim. For example, a staged loss or similar previous claim.  Referred to the Special Investigative Unit (SIU) – FRISS provides case management tools which allow the SIU team to assess alerts and manage the claims until its closure. Underwriting – fraud can be prevented by feeding back into underwriting claim history based on inputs like driver’s license.  ... Read More >
In my previous post, I discussed how analytics can help identify insurance fraud, but how can this be applied in the real world? There has emerged a relatively new technology specifically made to analyze and store relationships or graphs with blazing speed and flexibility. A graph is any type of networked data.... Read More >
Insurance is a big industry. In the U.S. alone, 7,000 companies collect over $1 trillion of premium a year, resulting in an extremely attractive market for fraud. The FBI and NICB (National Insurance Crime Bureau) estimates that roughly 10 percent of all non-health insurance claims totaling $40 billion a year are very likely fraudulent.... Read More >
Fraud occurs when someone knowingly lies to obtain some benefit to which they are not otherwise entitled to or someone knowingly denies some benefit that is due and to which someone is entitled. Insurance fraud occurs on both the claims and underwriting side, but we will limit the focus of this post to claims fraud. Claims fraud can be broken into two categories – “Soft Fraud” and “Hard Fraud”. Soft Fraud is used to define unwanted opportunistic behavior of normally honest people.... Read More >
Fraud….  For anyone in insurance, the word causes furrowed eyebrows and grim looks. It’s out there and we know it. It costs the global insurance industry tens of billions of dollars annually and has been around since the advent of insurance. Still, much of the work on ‘prevention’ has only occurred post-claim, mitigating the damage done and creating punitive precedents to discourage would-be fraudsters. Is it time for that to change? I think so.... Read More >