carrier’s investigative team can take a
closer look before proceeding, meanwhile
allowing low risk claims to be promptly
paid for higher customer satisfaction.
Filling the gaps
Most auto insurers leverage some external
data in their claims process, starting with
the first notice of loss (FNOL). However,
by using only limited data such as prior
claims, fraud may be slipping through the
cracks in the FNOL system. The personnel
trained to investigate fraud — SIU investigators — are dependent on claims triaging
systems and adjusters to receive case referrals. In the absence of robust analytics
at point of claim, referrals are often made
based on the gut instincts or personal experience the adjuster — a subjective and
often unreliable process that depends on
adjusters’ levels of experience, their vigilance and even their individual case load.
With the breadth and depth of data
now available, claims departments can
reinvent their claims triaging process.
With timely access to current and historical data related to the claims, carriers
can apply the latest generation of analytics that goes beyond just prior lessons
learned and gut instincts.
The types of data that assist in the fight
against claims fraud include having access to synthetic or fraud-related identity
information, relationships, vehicle sightings, criminal information, NICB alerts
and law enforcement intelligence. Next,
the use of the Department of Health and
Human Services (DHHS) exclusion list,
public records and contributory claims
and coverage data (both current and historic) public records, bankruptcy/liens
and judgements, and consumer info
such as address, moving violations and
Finally, using big data applications to
manage the volume of incoming claims
ensures that your valuable time and investigative resources are focused on the
right claims while not delaying the payment of low risk claims.
Tactics for changing the
• Faster claimant identification, with address and phone number verification
for faster turnaround.
• Inclusion of any fraud alerts or risk
score from the initial policy quote and
bind process that can be reviewed in
conjunction with any early or suspicious claims.
• Evaluate and score the digital profile
data associated with any online claims
• Prefill standard information for claims
operations so claims can be better triaged
and assigned to the most efficient and effective claim handlers, and then provide
them easy access to additional data as
needed — right at their fingertips.
• Claims that can immediately be identified as meritorious are to be fast-tracked through the system to prompt
• Complex or potentially questionable
claims are sent to experienced adjusters or referred to SIU who have data
visualization tools to see beyond the
provided data to identify underlying
relationships and suspicious linkages.
Customers desire a claims process
that is painless and straightforward,
and of course, they want their claims
to be resolved and paid quickly. In
fact, according to J.D. Power’s Claims
Satisfaction Study, cycle time is the
leading factor in influencing customer
satisfaction and customer retention.
The more streamlined the process, the
more positive the experience for the
customer, and most often, the best financial results.
What lies ahead
Fraud shows no signs of slowing down
even as insurance carriers engage customers online and through new, expanding mobile and digital strategies. Yet it
does not have to cripple auto insurance
carriers who take a combination of business process changes with anti-fraud
tools to provide a smooth customer experience while providing greater control
to their internal decision-making and
Lisa Volmar (lvolmar@transunion.
com) is the senior director of product
development for TransUnion’s Insurance
Solutions. Volmar has 30 years of
experience in building advanced
technological solutions and global
businesses to deliver products and
services to businesses and consumers.
CAN USE HUNDREDS
OF DATA POINTS TO
AND CLAIMS FRAUD.