Threat and Fraud Intelligence for Insurance

Insurance and Health Plan Fraud Detection

Fraud is a major problem in the insurance industry—and it shows no signs of letting up. A growing percentage of property & casualty, life and health plan insurance claims are fraudulent, costing the industry millions of dollars. The Global Economy is driving huge insurance claims fraud and money-laundering schemes, often involving sophisticated offshore networks of fake insurers, doctors and lawyers. The challenges are only intensifying as fraud types and frequency multiply. Perpetrators are developing new strategies designed to take advantage of weaknesses in information integration, while insurers are under greater regulatory and profit pressures than ever.

The IBM Fraud Detection Solution gives insurers a real-time analytical repository for recognizing the individual fraudsters and their associates before the loss is incurred:

Our solution:

• Delivers a comprehensive analytic capability for managing insurance claims fraud
• Enables insurance companies to recognize the true identity of all customers and claimants and their relationships to detect potential fraud, collusion and non-compliance while reducing operational loss and protecting brand equity
• Anchors a claims management system to a single, comprehensive, real-time repository of resolved and related identities including social and fraud network relationships
• Helps stop the threat at account opening, not at claim and investigation
• Extends relationship resolution to beneficiaries and collusive relationships
• Reduce false positives and negatives to meet KYC, Filtering, and AML regulations