Preventing Fraud: Claims Processing
The commoditization of Insurance and the high degree of regulation has made the insurance industry a target for fraudsters.
There are numerous soft and hard fraud attempts against insurers. Some of the most common fraud examples are, filing claims for fictitious accidents, multiple small claim requests and the impersonation of a claimant in order to route checks to a PO Box.
While insurance fraud is an expansive topic which needs advanced technologies and robust processes to curb abuse; often relatively simple changes can go a long way in protecting insurers from fraud.
In an effort to detect and control fraud, and improve the overall customer experience, our client wanted to ensure that claim payouts were being made appropriately on actual accidents.
Our client also wanted to incorporate various metrics to evaluate the number of claims filed by an individual claimant.
Y&L determined the simplest way to accomplish this was through integrating a SSN validation service with our client’s system. Where upon, every time a claims adjuster entered a name and SSN, the system performed a real- time validation to ensure the SSN and last name combination was valid.
The system was also set up to allow the use of a driver’s license #, State of residence and last name; which in-turn served the same purpose.
If the validation failed, the adjuster was allowed to override the declination, however, the resulting claim would require a manager’s approval for payout.
Insurance industry experts cite fraudulent claims and related activities negatively impact up to 35% of collected revenues.
While Y&L directly prevented fraud losses by integrating SSN validation, the indirect impact of this project is worth mentioning.
Fraud reductions equate to profitability increases, allowing our client to lower premiums. This helps our client become more competitive in the marketplace.
Moreover, requesting additional information and performing corroborating validation measures deter fraudsters from even following through with an attempt.
Y&L’s philosophy is information technology can transform businesses. We believe technology is a tool companies can use to do their business faster and more economically.
In short, technology, if designed and implemented correctly is a business accelerator, as well as competitive differentiator.
At Y&L, we blend business expertise, domain knowledge and technical prowess to deliver optimal solutions; so businesses can become more efficient, nimble, and competitive.
We have been transforming government agencies and commercial businesses worldwide since 1999.