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Using Data Analytics to Fight Fraud

In this blog I will discuss some of the most important topics to consider when addressing issues of data analytics as a fraud tool. Feel free to provide feedback on what you have seen successes in and what areas are still opportunities for you.

There are significant gains for companies that leverage data analytics. Carriers that use data analytical platforms will undoubtedly maximize their fraud detection capabilities and streamline this process with significantly reduced efforts. Having one analyst that is trained in this area and leverages the power of analytics can analyze and manage a significant number of claims; claims that would normally have to be reviewed using slow manual methods. Using this approach, a fraud unit can focus on those claims that have the highest potential for success, making them more effective and efficient and providing the most ROI for their efforts.

In addition to fraud units seeing significant gains from data analytics, the current claims environment is ripe to glean the benefits from these systems. Fraud solutions are inserted with the primary goal of detecting fraud, but at the same time these systems can also be used in the claims environment, thus, working in parallel with each other. There are an infinite number of areas within the claim process that can benefit from streamlining, starting with onboarding, to claims reporting, fast track settlement, workflow, third party data integration, and many other areas. Carriers that use analytics in both fraud and claims are seeing significant return on investment.

The future of leveraging data analytics is all about data; data management, inclusion, and integration, and at the core of this data is the technology that surrounds it. We are becoming data centric, an approach that is un-familiar in our industry. But, with all of this focus on data and technology, we can’t forget the human aspect of fraud fighting. Many carriers are starting to take a very myopic view of prevention and neglecting to include the people aspect of this endeavor. Employees that understand trends, patterns, and can see the more global picture are necessary for successful use and management of a data platform. We need to ensure that we are not too focused in our efforts that we forget that we need highly experienced people to run these platforms effectively.

Companies that use data analytics in the most effective way, do so by taking a more global look at the problem. These companies will insert fraud detection systems housed within the fraud departments, but also use that same platform in parallel to bridge data and information from the point of sale, underwriting, or claims environment. This will bring more data in the fraud system, data that will enrich and strengthen the fraud results and provide increased ROI.

There are many issues and challenges companies will face as they attempt to develop strategies in this new technologically infused environment, but companies can take a few steps to stay ahead of the curve and utilize these data analytical systems to their full potential.

Stay safe!

Dr. Fraud


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