Fraud and Claims Processing in the Era of Collaboration.
Shaku Selvakumar 060001XT47 firstname.lastname@example.org | | Tags:  bpm industry business_agility technology fraud_detection insurance claims_processing decision_management ibmimpact bizagility
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Contributed by Maneeza Malik, Industry Marketing Manager
As insurers embrace collaboration tools, social media networks and mobile applications to interact with their agents and policyholders, the need for a holistic approach to fraud detection and prevention when processing claims becomes more prevalent.
Fraud has long been a multi-billion dollar problem for the industry. Carriers must satisfy a policyholder’s expectation for speedy settlement with the need for proper due diligence when processing a claim. It’s a fine balancing act in an era where informed consumers will leverage social media sites to post their experiences with their insurance provider. Hence impacting a carrier’s reputation, brand and ability to attract and retain customers. Claims handling and resolution is the moment of truth for consumers and insurers alike.
When it comes to claims; fraud detection is still a siloed operation for many insurers. It’s either a back-office function or one that relies heavily on the expertise of adjusters to detect suspicious activity. Moreover, claim processing in it self is a complex and collaborative process from the time a claim is submitted via the call center, web or agent to the many individuals and iterations involved until its resolution.
So how should carriers address fraud detection as they revamp their claim systems and integrate collaboration tools and mobile apps to enhance their claims operations? First, leading insurers are rapidly adopting Business Process Management (BPM) and Decision Management (DM) to streamline and automate their claims process across lines of businesses. Second, fraud detection and prevention requires the effective use of analytics, BPM and DM early on in the claims process from the time the first notice of loss is submitted to identify and score suspicious activity, trigger alerts and route suspicious claims to an investigation team for further review.
Take the example of Worksafe Victoria, a mid-tier insurance carrier in Melbourne Australia that streamlined its’ claim process with Websphere BPM, DM and analytics achieving such results as speed to market gains, decrease in claim settlement time, reduction in claim and fraud costs with significant savings annually. To learn more, please watch a brief video:
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