Insurance Fraud Detection and Investigation
Assessing risk is crucial for insurance companies to reduce their exposure and protect their bottom line. Thanks to advanced claims fraud detection system, you can accurately identifies risks and automatically detect cases that require further investigation during the claim stages of the insurance lifecycle.
Understanding Insurance Fraud:
Insurance companies face various types of fraud, both organised and opportunistic. Here are the four main categories of soft and hard insurance fraud:
- Opportunistic Fraud: This type of fraud occurs in general and retail insurance, where individuals submit exaggerated or fabricated claims. In commercial insurance, the focus is on organisations committing fraud.
- Organised Fraud: Involving gangs, organised fraud schemes are carefully planned and executed to exploit insurance companies.
- Claims Fraud: Individuals or organisations make fictitious or intentionally inflated insurance claims. Examples include claiming for non-existent jewellery or staging slip or trip accidents.
- Application Fraud: Manipulating facts on insurance applications to lower premiums. For instance, falsely stating no previous insurance claims.
Differentiating between Opportunistic and Organised Fraud:
While opportunistic fraud arises from everyday situations where individuals find opportunities to commit fraud, organised fraud involves planned and coordinated schemes. Soft insurance fraud, such as inflating the value of legitimate claims, is more common than hard insurance fraud, which represents the minority of cases. Detecting and combating soft insurance fraud requires significant attention from insurance fraud investigators.
The Importance of a Dynamic Fraud Detection Approach:
Insurers prioritise reducing fraud losses and recognise the need to manage fraud as an ongoing risk. Fraudsters constantly adapt their methods to counter insurers' strategies, leveraging new technologies to perpetrate fraud over the internet. To protect honest customers and their own financial interests, insurers must adopt a dynamic counter fraud model.
Key Claims Fraud Indicators:
- Expert Rules: Utilising insurers' claims expertise and internal data to identify typical fraud indicators, such as accidents involving five or more people or claims filed within 30 days of policy inception.
- Geographical Rules: Localising individuals, places, and entities involved in claims and integrating external geographical data to assess environmental risk.
- Relational Rules & Link Analysis: Assessing risk based on relationships between individuals involved in the claim and any links to previous suspicious claims history.
- Analytics Rules: Employing advanced statistical techniques and predictive models to analyse data and identify patterns of fraudulent behaviour.
Boost Your Claims Process with Data Enrichment:
We offer data enrichment services to enhance your claims verification process. Uncover comprehensive information about any business, complementing your existing verification methods. Our offerings include:
- Company Reports: Access all statutory information filed by Irish and UK companies.
- Company Directors: View current and past directors and their involvement with other companies.
- Company Documents: Access documents filed in the CRO in Ireland, Companies House in the UK, and international registers.
- Ownership Structure: Discover beneficial owners of companies and explore group tree structures.
- Mortgages and Charges: Get details of all mortgages and charges registered against a company's assets.
- Monitoring & Alerts: Stay updated on any company or director with real-time notifications for new document filings, changes in status, risk level, or judgments