Fighting 21st Century Fraud

By Carlos Martins  |  October 22, 2013

Unscrupulous individuals and groups are using the same technological advancements to commit insurance fraud that businesses use daily for legitimate purposes. Meanwhile, organized fraud rings have been developing subtler ways to commit crimes on larger scales. Detecting such new fraud schemes is imperative to prevent illegitimate payments to those criminals.

To help in the battle, ISO has developed a guide to support insurers in combating fraud: Seven Ways to Fight 21st Century Fraud.

Learn what steps you can take to protect your company and your insureds. Here are some fraud-fighting strategies from the guide to consider:

  1. Take advantage of industrywide data. The most effective way to analyze claims is to have a broad view.
  2. Score claims quickly to decide whether to green-light or hold up payment. Getting a baseline analysis right at the start is a best practice.
  3. Don’t be one more victim of organized fraud schemes. They’re notoriously difficult to identify and require advanced analysis techniques to find.
  4. Put it all together with a link analysis program. Graphical representations of connected parties provide a wealth of insights.
  5. Use “scan alerts” to slow down payment of suspicious claims. Checking for red flags when the time a claim comes in can help keep fraud in check.
  6. Access external records quickly. Don’t get bogged down hunting for information from multiple sources.
  7. Investigate more efficiently. When staff members need to investigate, make sure they have tools to do so efficiently.

Carlos Martins

Carlos Martins, SCLA is Vice President and General Manager of ISO ClaimSearch Solutions. Carlos leads the operations of ISO ClaimSearch®, the property/casualty industry’s premier and only “all claims” database with over 1.2 billion claim records and market participation of more than 90 percent of the property/casualty insurance industry. Carlos is also responsible for the surrounding ecosystem of integrated solutions for ISO ClaimSearch which includes claim scoring, predictive analytics, third-party data, and visualization tools. Carlos brings to this role – and all ISO ClaimSearch participants – more than 30 years of experience in the property/casualty industry, where he has held a wide range of claims and technology roles. He is based in Jersey City, New Jersey and can be reached via email or 201-469-3103.