SIU Management Concerns: Improvement in the Antifraud Function

By James Horner September 26, 2012

At insurance industry conferences, a recurring theme from upper management is the search for strategic improvement in the antifraud function. For the most part, the industry has been working with the “train and wait” model. Companies organize an SIU staff, train the claims staff on fraud detection, and wait for assignments to investigate questionable claims.

Is there a new model that can help you increase productivity, boost effectiveness, and cut  costs? And how can you achieve those improvements while reducing uncertainty in a risky function?

This search for a better model has led to:

• more effective fraud detection technology — such as scoring tools, predictive modeling, link analysis, and network detection
• increased importance for the SIU analyst — who now needs to analyze data to solve more complex cases, help coordinate field activities, and assist in resolving cases
• a different profile for the investigator — computer-savvy, analytic-minded, and team-oriented

For more on this topic, watch our on-demand web seminar “Emerging SIU Issues at Insurance Industry Conferences,” presented by Thomas Mulvey, ISO’s national director of SIU and Claims Services.