Digital Edition

SYS-CON.TV
IBM's Advanced Analytics to Tackle Property & Casualty Insurance Claim Fraud
Designed to Help Protect P&C Insurance Companies from Illegal, Unethical, or Undesirable Activities

IBM has announced that it is putting advanced analytics to work zeroing in on fraudulent and abusive claims in the property and casualty (P&C) insurance industry. The IBM Loss Analysis and Warning Solution is designed to help protect P&C insurance companies from illegal, unethical, or undesirable activities by policyholders, service providers and employees. This is accomplished through a combination of data mining technology, data visualization techniques and a powerful scoring and anomaly discovery engine.

According to the National Insurance Crime Bureau, at least 10 percent of all insurance claims are either inflated or outright fraudulent, leaving the industry to pay out as much as US$30 billion annually in fraudulent claims. Recognizing the ultimate impact this fraud and abuse has on business and consumers, IBM designed the Loss Analysis and Warning Solution to identify fraudulent and undesirable behavior and provide data analysis capabilities for the P&C insurance industry.

This information can be used by insurance companies to detect a variety of unusual or suspicious behaviors such as inflated or unnecessary payouts to claimants, misuse by agents of policy discounts and detection of unusual claims charges and billing practices from service providers such as repair shops, doctors and hospitals.

With the new IBM Loss Analysis and Warning Solution, P&C insurance investigators create compliance models for claims, individuals and organizations expected to display similar behavior. The solution identifies normal behavior in these 'peer' groups and makes comparisons to rank and score members and identify unusual behavior. For example it would flag an auto repair shop that was charging for towing on nearly all repairs, while other shops had towing charges less than 20 percent of the time.

The Loss Analysis and Warning Solution can also be configured to immediately analyze a claim as it is filed as part of the claim review process. This helps insurance companies to avoid the "pay and chase" dilemma, where the claimant suspected of fraud is pursued and investigated long after the claim is paid.

Additionally, the solution offers an automated capability that acts as an "investigator-in-a-box." Rather than having the investigators develop the analysis parameters, this feature automatically applies analysis modules and logic to the data to identify questionable behavior, which can significantly increase productivity by freeing up the investigators to focus on case development and pursuit.

The new solution can be licensed for direct analysis or as an on-demand solution hosted by IBM at an IBM facility. It is based on the same technology as IBM's Fraud and Abuse Management System, developed over the last decade by IBM researchers and consultants in collaboration with health care insurance firms to detect fraud, waste and abuse in the health care industry.

The IBM Loss Analysis Warning Solution is available today through the IBM Center for Business Optimization. This group is putting advanced analytics to work by tapping into IBM's deep computing skills, industry consulting expertise and IBM Research's mathematical modeling capabilities to develop solutions that tackle complex problems involving massive data sets. In addition to risk management optimization, the Center offers solutions in the areas of supply chain management optimization, marketing investment optimization and dynamic pricing optimization. The Center is part of IBM Global Business Services.

About ITSG News Desk
ITSG News Desk trawls the world's news sources for stories and updates on IT solutions that deliver ROI by reducing costs and/or cutting time-to-market, as well as other products and services that can produce bottom-line gains for enterprises.

In order to post a comment you need to be registered and logged in.

Register | Sign-in

Reader Feedback: Page 1 of 1



ADS BY GOOGLE
Subscribe to the World's Most Powerful Newsletters

ADS BY GOOGLE

The explosion of new web/cloud/IoT-based applications and the data they generate are transforming ou...
CI/CD is conceptually straightforward, yet often technically intricate to implement since it require...
Containers and Kubernetes allow for code portability across on-premise VMs, bare metal, or multiple ...
Enterprises are striving to become digital businesses for differentiated innovation and customer-cen...
Digital Transformation: Preparing Cloud & IoT Security for the Age of Artificial Intelligence. As au...
DevOps is often described as a combination of technology and culture. Without both, DevOps isn't com...
The now mainstream platform changes stemming from the first Internet boom brought many changes but d...
DXWorldEXPO LLC announced today that All in Mobile, a mobile app development company from Poland, wi...
DXWorldEXPO LLC announced today that Ed Featherston has been named the "Tech Chair" of "FinTechEXPO ...
Chris Matthieu is the President & CEO of Computes, inc. He brings 30 years of experience in developm...
Bill Schmarzo, author of "Big Data: Understanding How Data Powers Big Business" and "Big Data MBA: D...
Andi Mann, Chief Technology Advocate at Splunk, is an accomplished digital business executive with e...
In this presentation, you will learn first hand what works and what doesn't while architecting and d...
The Internet of Things is clearly many things: data collection and analytics, wearables, Smart Grids...
To Really Work for Enterprises, MultiCloud Adoption Requires Far Better and Inclusive Cloud Monitori...
We are seeing a major migration of enterprises applications to the cloud. As cloud and business use ...
If your cloud deployment is on AWS with predictable workloads, Reserved Instances (RIs) can provide ...
Disruption, Innovation, Artificial Intelligence and Machine Learning, Leadership and Management hear...
We build IoT infrastructure products - when you have to integrate different devices, different syste...
Consumer-driven contracts are an essential part of a mature microservice testing portfolio enabling ...