Three Important Tips for Special Investigators

By Thomas Mulvey April 10, 2014

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Organized insurance fraud is becoming increasingly complex in both emerging and maturing markets. In the United States, the current impact of fraud upon the property/casualty insurance fraud is estimated to be as high as $64 billion, according to the most recent figures from the Aite Group.

1. Make your data productive: In many markets, the term “big data” is intimidating. How big is big enough? Many companies wonder whether their structured and unstructured data is usable and useful. Any amount of data is a starting point, and as you look at all the information your company stores, you’ll find plenty to help your investigators.

2. Rethink your talent: Feet on the street will always play a crucial role in the global insurance special investigative unit (SIU) community. But the support investigators need has evolved. SIU analysts have become essential to developing the connections among parties in an organized insurance fraud scheme. Using big data and advanced analytical tools, SIU analysts can accomplish in days what used to take weeks.

Read our case study on NetMap for ClaimSearch. >>

3. Measure success the right way: It’s tough to gauge the success of an SIU. Shutting down an organized fraud scheme prevents future losses, but it’s impossible to measure effectively what won’t happen. Recoveries tend to be small, rendering them impractical as a key performance indicator. Yet that doesn’t mean you can’t measure SIU success. Tracking the number of major cases completed is a good place to start. Further, a high concentration of cases involving risks in their early stages speaks to an SIU’s ability to detect and act on suspicious activity quickly. When you take that approach, you can prevent the bulk of the potential damage.

Learn about the organized fraud “business cycle". >> 


Thomas Mulvey

Thomas Mulvey has been in the business of insurance investigations for more than 27 years. In his current position, he serves ISO as assistant vice president of SIU and claim services. He is also the coordinator of ISO’s Insurance Fraud Management Conference.