Claims Fraud Mitigation: Is it part of business strategy?

Claims Fraud Mitigation: Is it part of business strategy?

Each week we see more and more articles and research reports regarding Fraud in the insurance industry. Celent?s recent report (www.celent.com) indicates fraud ?mitigation? is a key element of an insurance company?s business strategy. We agree! And as the research brief points out the vendor solutions in the space are widely different and carriers need to carefully evaluate their needs against the vendor solutions.

Traditional methods determining a claim score during claims processing is one of the entry level capabilities; however, the ability of placing the predictive variables what describes a potential fraudulent insured into the underwriting process can be one of the next. But we cannot forget the claimants who are not the insured.

Fraud has no boundaries and our fraud strategies need to span all aspects from underwriting, claim intake, claim payments and leveraging all data and information available. While technology becomes more sophisticated, so does fraudulent activities and schemes. We welcome your feedback on mitigation methods which are providing additional insights.

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