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

SYS-CON Events announced today that Daiya Industry will exhibit at the Japan External Trade Organiza...
SYS-CON Events announced today that Nihon Micron will exhibit at the Japan External Trade Organizati...
SYS-CON Events announced today that Massive Networks, that helps your business operate seamlessly wi...
SYS-CON Events announced today that Suzuki Inc. will exhibit at the Japan External Trade Organizatio...
"Our strategy is to focus on the hyperscale providers - AWS, Azure, and Google. Over the last year w...
21st International Cloud Expo, taking place October 31 - November 2, 2017, at the Santa Clara Conven...
Enterprises are moving to the cloud faster than most of us in security expected. CIOs are going from...
Many organizations adopt DevOps to reduce cycle times and deliver software faster; some take on DevO...
SYS-CON Events announced today that mruby Forum will exhibit at the Japan External Trade Organizatio...
The last two years has seen discussions about cloud computing evolve from the public / private / hyb...
SYS-CON Events announced today that B2Cloud will exhibit at SYS-CON's 21st International Cloud Expo®...
SYS-CON Events announced today that SIGMA Corporation will exhibit at the Japan External Trade Organ...
SYS-CON Events announced today that NetApp has been named “Bronze Sponsor” of SYS-CON's 21st Interna...
Agile has finally jumped the technology shark, expanding outside the software world. Enterprises are...
SYS-CON Events announced today that MIRAI Inc. will exhibit at the Japan External Trade Organization...
There is huge complexity in implementing a successful digital business that requires efficient on-pr...
SYS-CON Events announced today that Keisoku Research Consultant Co. will exhibit at the Japan Extern...
You know you need the cloud, but you’re hesitant to simply dump everything at Amazon since you know ...
SYS-CON Events announced today that Fusic will exhibit at the Japan External Trade Organization (JET...
Most of the time there is a lot of work involved to move to the cloud, and most of that isn't really...