Combating New Insurance Company Fraud Using Innovative Tools
The COVID-19 pandemic is remaking the world, including insurance company fraud and ways to fight it. Physical distancing and business shutdowns during the pandemic meant that claims investigations went online and virtual. Such forced innovation can be good for both insurers and claimants. But, it also created new opportunities for fraudsters to game the system.
Recently, Clearspeed Chief Product Office Jules Erlich joined a panel of experts during the Claims Innovation USA virtual event to discuss combating new fraud trends using innovative technologies. Other panelists included Brian Wilson, Vice President Special Investigations at QBE North America and Nirmal Paul, Vice President – Fraud Prevention Unit & Claims Investigation at Bajaj Allianz Life Insurance.
Paul described several scenarios where people tried to use the switch to online investigations to cheat insurers. Individuals used identities stolen from people who died during the pandemic to try and pass off their siblings as valid claimants. Criminal cartels conspired to pass off cancer victims as car accidents victims to collect on claims. This particular large-scale fraud roped in doctors and lawyers willing to cooperate for a slice of the action. In both cases, criminals hoped that the lack of face-to-face investigations would work in their favor.
What new tools can insurers use to detect fraud in online and virtual investigations?
Organizations are now using innovative solutions in detecting claims fraud—voice analytics, text analytics, NLP capabilities, automated business rules, predictive analytics and social media analytics.
One challenge is achieving the right balance of digital and human agents to create an effective counter-fraud workforce. Another challenge is creating an effective ecosystem of tools to provide a complete picture of true and fraudulent claims.
Ehrlich pointed out that Clearspeed’s unique voice analytics fills an existing gap in insurers’ fraud detection ecosystem. The current ecosystem provides a historical perspective through examination of public records, financial records, social media content, and other sources. No tool in the existing ecosystem provide insight into a claimant’s current state.
Clearspeed’s voice analytics assesses the risk of inaccuracy in speech with 95 percent accuracy. For insurance claims investigations, this assessment provides a quick and valuable alert about claim accuracy.
To handle claims in a global and diverse online world, Clearspeed’s technology is language agnostic. The assessment analyzes not what is said, but how it is said. It also works with simple yes / no questionnaires or more complete conversations about claims.
According to Ehrlich, the insurance industry is progressing towards online claims submitted verbally instead of using a keyboard. Such claims innovation will require voice analytics to speed the claims process and detect fraud early on.
Watch the event recording and gear up to fight fraud remotely with advanced counter fraud awareness and technical skills.