ClearspeedClient case study
El Roble Seguros Sees 31x ROI in First Year with Clearspeed Voice Analytics
Challenge
Auto insurance fraud ranges from misrepresenting facts on insurance applications and inflating insurance claims to staging accidents, submitting claims for injuries or damage that never occurred, and false reports of stolen vehicles.
According to the Coalition Against Insurance Fraud, fraud occurs in about 10% of property-casualty insurance losses. That’s a significant amount of fraud.
Spotting claims that may be fraudulent is difficult even with sophisticated tools.
El Roble embodies a culture of innovation. Already using FRISS to automate their fraud detection process and help reduce their claim handling time, they began looking for a solution to bolster their current fraud detection technology stack.
Solution
Clearspeed voice analytics is used to identify risk at scale and reduce fraud.
The solution is based on people completing a brief automated phone questionnaire with simple yes or no questions. The questionnaire can be conducted in any language.
Questionnaire responses are analyzed and assigned a low-to-high risk level. Results are used as an additional data source in the claims review and approval process. Claimants flagged as low or average risk could be cleared through the process much faster unless there are other indicators to the contrary.
High-risk claims may require additional follow up based on the specific question, the risk profile of the company, or the value of the claim. Clearspeed results allow our customers to focus their scarce investigative resources on the areas of highest risk.
Outcomes
Combined Clearspeed with FRISS to pinpoint claims fraud
Enabled STP for low-risk claims
Allowed for focused follow up on high-risk claims
Optimized overall claim close time
Key Results
- ~$400 average savings per claim
- Up to 30 times faster claim payout
- 31X ROI
Clearspeed enables us to speed up the claims process, focus our resources on the risky claims, and save money by ensuring fraudulent claims are properly investigated and denied.
Jorge Luis Linares
Assistant to the CEO, Seguros El Roble
Implementation
For Seguros El Roble, the largest auto insurance provider in Guatemala, identifying fraud is an ongoing challenge. Given
the tough economic environment, the team wanted to enhance their claims process.
The company currently uses FRISS to identify claims for investigation. For additional fraud analysis, El Roble awas to their process. Adding Clearspeed was very simple and only took two months to move from project start to full implementation.
Now, once claims are initially scored using FRISS, the analysis team decides whichcases to investigate.
Claims with high-risk scores from FRISS are further vetted using
Clearspeed.
Objective rules from FRISS’s data engine, coupled with unbiased voice analysis fraudalerts from Clearspeed, provide optimal outcomes for all claims. Most customers aresped through the automated claims process while the risk-alerts from FRISS
and Clearspeed shine the spotlight onthose cases which should be investigated thoroughly by SIU professionals.
