PredictiveClaims Detect and Prevent Property and Casualty Insurance Fraud

Detect and Prevent Property and Casualty Insurance Fraud

It’s a well-known fact that approximately $30 billion in losses is attributed to property and casualty insurance fraud in the U.S. alone. According to the Insurance Research Council (IRC), most property and casualty insurers have both voluntary and mandated systems for detecting and preventing fraud. Many, however, rate their efforts as only moderately effective (Fighting Insurance Fraud, 2002).

PredictiveClaims enables property and casualty insurers to catch a greater percentage of fraudulent claims—even when managing high claim volumes.

With PredictiveClaims, you can:

Reduce costs related to both fraud losses and ineffective fraud prevention initiatives
Understand why claims are flagged, so agents and Special Investigation Units (SIUs) can investigate claims more efficiently
Automatically detect new forms of fraud with analytics that “learn” from the data
Create detailed risk profiles by combining information from field notes and other sources of textual claims information with traditional claims data

Detect fraud more accurately with multi-stage assessment

PredictiveClaims makes assessments at several stages in the claim handling process, to evaluate claims based on the most recent information. For example, a claim may be checked at first notice of loss, when the names of all involved parties are entered, and prior to payment of the claim. This ensures that your settlement decision takes into account all of the information available for a particular claim. This multi-stage assessment process helped one customer improve the performance of its fraud detection system by 25 percent.

Maximize investigative resources

PredictiveClaims assigns a risk score to each suspicious claim, and provides specific reasons for the decision. This helps claim handlers and investigators know why a claim is flagged, so they know where to focus when following up with the claimant or beginning an investigation.

Reduce risk with intelligent marketing

With SPSS predictive analytics, your company can detect existing fraud—and prevent future occurrences—by marketing to the right prospects. The SPSS predictive analytics family includes applications for developing targeted inbound and outbound marketing campaigns. When you incorporate fraud profiles from PredictiveClaims into your marketing analysis, you know which prospects present the greatest potential risk and which offer the greatest potential value.

For example, one PredictiveClaims customer discovered that certain claim types are rarely fraudulent, and used that information to refine its legacy fraud detection system. In addition, the company developed an early warning detection system for new types of fraud, and plans to use PredictiveClaims to assess the risk of new insurance applicants, helping to improve the quality of its customer portfolio.

To learn more about PredictiveClaims and the SPSS predictive analytic applications, contact an SPSS Account Representative today.

Contact SPSS Sales

PredictiveClaims™

Detect fraud more accurately with multi-stage assessment

Maximize investigative resources

Reduce risk with intelligent marketing