The National Insurance Crime Bureau estimates insurance fraud has escalated by 19 percent since 2009. To detect more fraud, reduce false positives, and improve investigator efficiency, insurers now have the latest version of SAS Fraud Framework for Insurance.
Enhancements include streamlined social network analysis, pre-built insurance content for better fraud detection, and the new SAS Financial Crimes Monitor.
“Insurers are catching up with the rest of financial services in preventing fraud. With questionable claims at all-time highs, insurers need advanced analytics and link analysis to identify and prevent fraud sooner,” said Stephen Applebaum, senior analyst for property & casualty insurance, Aite Group. “Insurers benefit significantly: reducing false positives means processing legitimate claims faster, reducing overhead while improving customer experience and retention.”
SAS Fraud Framework for Insurance has new social networking capabilities, including a network hierarchy layout; greater flexibility to merge, hide or remove network entities; and adding annotations, such as text and images. The added functionality improves investigator efficiency while reducing false positives, increasing return on investment per investigator.
The solution incorporates prebuilt insurance content, such as an extendible data model and industry-specific red flag business rules and models for detecting property & casualty fraud. The solution can also integrate external data from sources like NICB.
The SAS Financial Crimes Monitor helps users to logically manage rules, models and alerts. The fraud scoring engine can detect more fraudulent activities by easily updating and maintaining business rules and advanced analytic techniques in the solution.
“SAS is a powerful tool in fighting fraud—we've already seen good returns,” says Tim Wolfe, director, special investigations unit, at CNA. “Technology, especially predictive analytics, helps us consistently identify subtle indicators of fraud and better grasp how much fraud is out there. SAS provides a better gauge of claim fraud exposure, minimizing missed opportunities while accelerating the identification of sophisticated schemes that could go undetected. With this new SAS support, we anticipate a 20 percent increase in annual referrals to SIU.”
CNA uses the social networking component of SAS Fraud Framework for Insurance to identify major cases of organized suspicious activity.
”With the social networking component of SAS Fraud Framework for Insurance, we project 12 major cases annually in our business case, translating into approximately $500,000 in savings per year,” Wolfe says.
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