Advanced Fraud Detection and Management Solutions Help Reduce Losses

Worldwide Industry Marketing Manager for Insurance, IBM

Interest is growing among insurers for big data solutions that can help them identify, monitor and manage fraud in their underwriting and claims.

Advanced fraud detection and management solutions are helping P&C and life insurers reduce losses by improving the precision and timeliness of fraud detection.

The IBM vision for fraud analytics is based on applying a series of interlocking tools to address fraud across its lifecycle:

  1. Investigate - Build a case for prosecution or denial of benefits
  2. Prevent - Stop fraud before it is reported
  3. Detect - Detect fraud once it is reported – and react accordingly
  4. Discover - Discover fraud after it occurs

With help from IBM solutions for big data, fraud and abuse no longer have to be discovered when the fraudster makes a mistake; we can proactively examine massive amounts of data in real time to predict, prevent and prove fraudulent claims.

Reducing fraud at each stage of the claim lifecycle

  • Underwriting: To prevent fraud, underwriters can examine details about the submission including agent, risk and any named parties, along with behavior details about how the risk was submitted.
  • Intake: At intake, identities and the behavior associated with reporting the claim are analyzed, along with the claim pattern to determine if there is the potential for fraud.
  • Investigation and adjudication: As the adjuster works the claim, he can apply analytics to identify the potential for fraud as data is collected throughout the process.
  • Evaluate loss data: Using discovery-based analysis, adjusters can continuously examine structured and unstructured data for outliers, patterns, and matches to known fraud data to generate a claim fraud potential score to present to special investigators.
  • Investigation: Adjusters can use case management technology to manage the investigation process, recover losses or prevent payments, connect to related cases, and prosecute if possible.
  • Monitoring and reporting: A performance-monitoring dashboard, visualization, and drill-down reporting help managers understand trends and the impact of fraud on the business.

With a range of configurable solutions that help clients manage their fraud process, including analytics and case management, IBM is a clear leader in big data solutions for fraud detection. According to numbers verified by a leading industry analyst firm, IBM has the largest number of clients for fraud analytics solutions.

Attend our webcast, Fighting Insurance Fraud with Big Data, to learn how next-generation fraud solutions can help you prevent, predict and investigate claims fraud.

Register to attend Fighting Insurance Fraud with Big Data


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