Insurance Claims Analysis: Your Own Data Isn’t Enough

By Carlos Martins  |  December 3, 2012

Most proactive claims management tools — from business processing rule engines to SIU claim identification systems — focus only on insurers’ own data. After all, what else do carriers have access to? While this approach can increase the effectiveness of a claims department both in processing meritorious claims and in referring questionable claims for investigation, it provides just a narrow view of claims activity across the United States. A claimant may appear legitimate to one carrier merely because his or her history with another insurer isn’t immediately evident.

To streamline claims-handling operations, you need the benefit of both new technology to identify anomalies and the broadest collection of data available against which to apply it. That combination will enable you to develop the features needed to identify questionable activity (or a candidate for fast-tracking) and the greatest resources for reaching that determination.

ISO ClaimSearch® has become exactly that sort of platform. Beyond offering the broadest view of insurance claims activity in the United States, with more than 800 million claims records so far, we’re developing systems that flag suspicious activity, giving the claims handler an opportunity to determine quickly whether more investigation is necessary. In addition to tackling foreclosures, we’re working on systems for other data sets to integrate with ISO ClaimSearch, resulting in, effectively, background scans that alert users only when a closer look at a claim is necessary.

Claims departments continue to seek new ways to optimize their operations, addressing legitimate claims quickly without letting questionable claims fall through the cracks. The current trend toward predictive analytics using
Big Data can help. But in the future, the true advantage will come from having the broadest perspective
in the industry on claims activity in the industry. Use ISO ClaimSearch as your starting point, and pair it with additional products that analyze data quickly and thoroughly. The results you get will support sharper decisions, and in the process, you’ll make your claims handlers more productive without alienating your best customers.

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.