Insurance Fraud is one of the top challenges that insurers are facing worldwide. While there are pricing pressures owing to slow economic environment, cutting back the Claims payout is one of the best means to increase efficiency and cut cost. From a strategic perspective also, carriers overall success to a large extent depends on the manner they treat their Claims function; for many insurers Claim processing efficiency is often their unique selling proposition. Reducing Claim leakages by effectively fighting against insurance Fraud and having a larger focus on recovery management can help insurers reduce their Claim cost. This article is an effort to highlight five key areas that should be considered when building an effective Fraud management strategy.
From a Fraud perspective, effective management of First Notice of Loss (FNOL) process is crucial for the insurance company. Through improved workflow, streamlining the processes and use of automation, insurers can identify the Fraud triggers and recovery possibilities early in the Claims cycle. The insurers should make use of early warning systems like, Voice Analytics for timely identification of Fraud. There are key factors for example, who reports the Claim (Claimant vs. Attorney Vs. anyone else); the time when the Claim is reported (Immediate vs. Delayed reporting); and the manner in which Claim is reported that can raise suspicion on the genuineness of the loss. Any delay in identifying the Fraud triggers can have serious consequences later. If the decision to make an SIU appointment is late, the insurers can lose important eyewitness that can affect the Fraud analysis and the recovery possibilities. Any time lost during this stage will cause more than four times efforts, time and cost in the future. To fight the Fraud in an efficient manner, insurers have to be wiser and faster in comparison to Fraudsters. The use Data Analytics to narrow the possible number of Claims to be investigated for Fraud is vital. The insurers can then pay attention to those Claims, where high probability of Fraud exists.