Leveraging Fraud Detection to Enable Straight-through Claims Processing

Apr 1, 2021

Olcay Krandaoglu

Levereging Fraud detection image
Levereging Fraud detection image
Levereging Fraud detection image

Let’s be honest. In today’s insurance industry, the concept of straight-through processing is nothing new. With the digitalization of processes skyrocketing, processing policy applications or claims as fast as possible is key in providing excellent customer service. According to a study by Insurance Hub, insurers that deliver on customer expectations through a simple and seamless claims experience build trust and loyalty. In order to enable this swift customer experience, there are many dependencies. One necessary capability is automated, real-time fraud detection. Low-risk claims can be put on a fast track in order to provide sincere customers with a moment of magic at times when it matters most. On the other hand, risky claims will be automatically flagged for further investigation. Enabling straight through processing is a great achievement that benefits honest customers but providing these capabilities should not come at the cost of processing fraudulent claims. An automated fraud detection solution, when leveraging both AI and expert rules, can increase straight through processing capabilities by 20-30%.

A real life example

One of the most successful FRISS insurance customers estimates that 97% of their customers are sincere. They strongly believe that these customers deserve better than the arduous, antiquated process of claims fraud detection. This customer focused approach is why they deployed their strategic P&C anti-fraud initiative. One of the driving engines in this initiative is FRISS Fraud Detection at Claims. The FRISS Claims solution helps the carrier to realize future-proof growth and improved customer experience through digital transformation. Besides stopping fraudulent claims before they are paid, which results in a bottom line financial impact of $21 million, an important feature is the ability to leverage the benefits of claims segmentation. Sincere claims are processed via a fast track, with little or no human intervention. This is possible because the anti-fraud solution is seamlessly integrated with their core insurance systems, ensuring instant adoption with the insurers’ claim adjusters daily tasks. This insurer realized a number of tangible benefits:

  • Out of the 70,000 CASCO claims, 20% are fast tracked

  • Saving $2.5million a year by avoiding manual checks of legitimate claims

  • Customer experience and satisfaction are greatly increased

According to analyst firm Celent, this insurer made a great technology partnership decision by working with a vendor who offers proven specialized solutions. FRISS leverages a combination of expert rules Network Analytics, Text Mining and AI to enable the ideal customer journey.

Digital claims transformations for great customer care

Customer service is more important than ever. As stated by McKinsey research, success depends on the ability to deeply enable a digital way of working. This is also an important pillar in the success of the above example. Utilizing FRISS’ solutions, carriers  managed to realize a true fraud-fighting culture with cross-border cooperation and knowledge exchange. By ensuring a holistic view of each incoming claim, scored in real-time, customers who deserve special attention and care, especially in difficult times, feel the benefits.