Are a seemingly endless number of assignments bogging down your special investigations unit (SIU)? The first step in handling that problem is to triage referrals at the top of the investigative funnel. While that approach presents its own challenges in a manual environment, automation can make life much easier — identifying false positives, helping to prioritize cases, matching the right case to the right investigator, and facilitating more efficient use of SIU resources.
Here are five ways you can unclog your SIU through technology-enabled triage:
1. First notice of loss (FNOL): Well before considering calling in the SIU, you can start weeding out cases you shouldn’t investigate. Minimizing false positives as early as FNOL alleviates pressure on the entire claim handling process, enabling desk and field adjusters to make better decisions about which claims to send to SIU. Such efficiency is quickly becoming more critical, as more fraud ring assignments create less tolerance for false positives.
2. Use the right indicators: There is plenty of valuable information in your ISO ClaimSearch® match reports, but you can make the reports even more powerful with a claim scoring system such as ClaimDirectorSM. It will give you a better sense of which claims to refer to an SIU.
3. Add to your claims data: It’s no secret that SIU professionals are “data hogs” — the more, the better. You can use additional data more efficiently by scanning third-party databases automatically as part of the FNOL process — for example, with the new ISO ClaimAlert™ suite. For more reports, such as weather forensics and social media analysis, a third-party data portal such as Decision Net® can help.
4. Consolidate case management: Centralized data facilitates smoother, smarter management. Integrating your major case management tool (for example, SIU Case Manager) into ISO ClaimSearch not only makes it easier for adjusters to refer cases to SIU, it also supports rapid and detailed summary reporting. SIU managers can use the tool to assign cases, set priorities, and track progress. That approach increases efficiency and productivity, frees up resources without additional hiring or incremental investment — and at the same time vastly reduces administrative weak spots and risks in your organization.
5. Increase detection speed: Sifting through disparate data takes time, and investigations can miss important connections. Automated, proactive systems can help unearth indicators of organized claims fraud, resulting in faster and deeper investigations that ultimately provide insurers considerable savings. Look for a proactive organized-fraud detection tool — applying predictive analytics to ISO ClaimSearch — in third-quarter 2013.