Since the onset of the pandemic, insurance carriers have seen an uptick in consumers’ digital activities across both underwriting and claims. Nearly 70% of carriers said this increase in digital activity was accompanied by growth in identity fraud, according to a survey by LexisNexis Risk Solutions and Aite-Novarica Group.

The most common points of entry for identity fraud among property and casualty insurance carriers are underwriting or the point of application, customer service or at the point of account and claims at the point of payment, according to the survey.

Let's look specifically at achieving that across claims.

Adopt a multilayered approach featuring a range of tools. No single technology will adequately detect and prevent every type of fraud. 

  • Start at eNOL and FNOL processes and workflows
  • Access and analyse the 80% of hidden unstructured data 
  • Combine human intuition with rules engines and AI
  • Remember fraudsters have access to the same technology and innovation as you

Start at eNOL and FNOL

The first step is to ensure your eNOL process is integrated with major identity service providers to enable a convenient and yet secure single sign-on process. Rather than just asking for date of birth and first line of address. 

The desire for automation and straight-through-processing may actually hinder fraud detection especially for lower cost claims like accidental damage (A&D).  OK, AI may check if the photo of damage to a TV has been altered, taken on a different date or a different place to that claimed. But many inflated, opportunistic  claims can slip through as the data looks normal. 

Customised eFNOL can nudge such customers to voluntarily withdraw claims- up to 35% in the case of Home A&D. 

Having to provide a brief description of the loss or damage first and then at the next step getting the claimant to send 3 to 5 photo images will make them pause a moment. Then a third stage of adding a video to give context between disparate photos will deter opportunistic fraud.

The digital claims platforms like RightIndem, Synergy, 360SiteView, Snapsheet etc let you achieve this whilst still keeping the process short. Better still they allow you to change the way you collect the data and anticipate changing behaviour.

World Programming integrated AI driven analysis of speech for those calling claims handlers and wil demonstrate how they detect fraud and have integrated this with Duck Creek and soon with some insurtechs. 

Then the harder to find professional fraudsters can be detected with the counter-fraud solutions like Shift, Friss and NetReveal.   

Access and analyse the 80% of data you usually ignore.

Yes- 80%! Don't believe it then look at Gartner and other research.

That's the unstructured data in free-form fields, text in reports, surveys and emails. From multiple sources in disparate formats.

Leave this massive data unanalysed and, however many counter-fraud apps you license, your success will be limited. Software like 360Retrieve can search or, surface and analyse this data and make it 'AI-Ready'. 

Combine human intuition with rules engines and AI

You cannot leave fraud detection to just software and automation. Augment the experience, knowledge and skills of fraud specialists with technology to build rules and rules engines to counter the ever-changing MO of professional fraudsters. And constantly improve algorithms 

The multi-layer fraud strategy lets you build these lines of defenses combining the strengths of each approach to bridge gaps in individual technologies. 

Whilst in data, do not forget the data specialists which add more sources and external data to help counter raid e.g. Synectics Solutions. Their mission is to help insurers, banks, central and municipal  governments have the most complete data to maximise fraud detection and prevention.

Remember fraudsters have access to the same technology and innovation as you

Professional fraudsters around the world also leverage technology and the sharpest cyber-crime minds to breach your defences which is why it is so important to deploy a multi-layered approach with more than just one fraud solution in place. And take advantage of professional inspections and survey companies like Roberston & Co in the UK that combine human intuition with the best of technology and face-to-face interviews with virtual engagement. . 

Another reason to have technology that lets you make constant iterations and changes to stay one or two steps ahead for fraudsters. 

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