Battling Fraud With Automation

Battling Fraud With Automation

December 03,2018

According to the FBI, the total cost of insurance fraud (not related to health) is more than $40 billion a year, costing the average family in the U.S anywhere between $400-$700 per year recognized in the shape of increased premiums.


We all know by now that fraud can come in all shapes and sizes in the form of an exaggerated claim, an entirely false or partly false claim, or omission of information in order to pay less. No surprise that by now, every agency in the industry is aware of the growing threat of fraud. The only way to prevent fraud, is to get ahead of it. The best way to get ahead of insurance fraud, is to two-fold. First, don’t underestimate them. They are intelligent, which we can tell by the increasingly creative ways consumers cheap the system. Second, while technology is the rope in this tug of war between business and fraudulent consumers, it is also your greatest asset; that is, if it’s strong and up to date.

 Check it out: Leveraging AI For Insurance

The up to date part is important. Many insurance agencies are still using legacy technologies day to day and expect these tools to step up to the task. Unfortunately, they won’t. The truth is, legacy technology such as older generation devices cannot keep up with the systems and process that need to be performed in order to effectively monitor for fraud. They are not efficient or fast enough to get ahead of any false claim. With up to date, modern technology, agencies can compare and confirm claims information with up to date pubic records, and online databases with the consumer’s report.

 Check it out: Automation In Insurance Infographic

One of the most popular methods of using technology to battle fraud, is AI based automation. Artificial Intelligence has come a long way since it first made its way into the Insurance industry. The technology has evolved and of course, learned a lot since its debut. Utilizing AI automation for your agency is one of the bets decisions you will make in the effort to detect fraud. Fraudulent claims cost insurance companies’ tons of money that they otherwise wouldn’t be paying back if there were better ways of detecting the fraud before a large pay out.


So how does AI automation software help you weed out the fake claims from the real ones?


AI uses advanced algorithms to detect any inconsistencies or quirks found in a claim, which helps to improve the way agents are able to sort out the bad claims from valid ones, thus, saving the agency both money and time as well as looking out for other trustworthy customers.

Check it out: How To Introduce New Technology Into The Workplace

Again, artificial intelligence is smart and is constantly learning as it works. These tools have the ability to not only detect an inconsistency in a claim, but they also have the ability to spot out connected groups of people that filing strikingly similar claims with the same doctors, lawyers, etc about injuries from car accidents or other types of injuries.

 Check it out: Insurance Claims Automation Video

Humans make mistakes. They read too fast, are distracted easily, and often assuming of the claims that come across their desk. So, it’s no surprise that oftentimes, fraudulent claims go unnoticed and the agency ends up doling out a ton of money for customer pay out that could otherwise have been avoided if the AI algorithm was involved in sorting out the claim. This doesn’t mean the agent’s job is useless or as unimportant as that of the automation software, but the role they play is different. Instead of spending hours managing the same claim, by allowing the software to do most of the heavy lifting to organize and manage the information, the agent can begin other work and increase productivity.

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