Fraud
3 keys to stopping medical provider fraud, waste, and abuse
It’s no secret that medical fraud is a big problem, with some sources estimating the cost at more than $200 billion annually. But knowing the problem is one thing.…
Getting serious about fighting medical provider fraud
Complex medical bills can make it difficult for adjusters—already overloaded with cases—to find potential fraudulent or excessive billing.
Life insurance fraud: A holistic claims view key to detection
Life insurers can face a myriad of challenges today. Some of those issues have plagued the industry for years—such as stagnant premium growth and low interest rates—while…
NYCM Insurance implements Verisk’s ClaimDirector and NetMap fraud detection solutions
NYCM Insurance has implemented Verisk’s newly enhanced ClaimDirectorSM and NetMap for ISO ClaimSearch® solutions to assist in accurate and early detection of potential…
CMS to mask health insurance claim number and social security number on contractor correspondence starting April 2019
Starting 4/1/19, CMS’s Coordination of Benefits and Recovery Program program will mask the social security number (SSN) and SSN-portion of the health insurance claim…
Uncover key claim details with social media
The average person spends two hours a day on social media. Hidden within the sea of tweets, snaps, and posts on these social platforms is valuable information for the…
Uncovering fraud in auto extended warranty insurance
For most drivers, purchasing an extended automotive warranty for their vehicle means peace of mind in the event their vehicle malfunctions and needs critical repairs. For…
5 questions to ask before building a claims fraud analytics system
With the industry focus and media attention on data analytics in insurance, many SIU leaders are considering enhancing their team’s investigative capabilities with a…
Can insurance mitigate GDPR-related risk?
In the wake of the implementation of the European Union’s General Data Protection Regulation (GDPR), businesses worldwide are developing policies and processes to address…
How a professional’s reputation can expose inflated claims
Trusting information at face value is a thing of the past. Claims professionals know this well, because they must gather information on a claimant and research prior…
Blockchain security scrutinized
Blockchain technology has been getting a lot of attention recently, beyond just its role as the technology underlying “virtual currencies” like Bitcoin. Some have…
Ethics and data: Value in mature governance
Data can have many positive applications, but there can also be many risks with increased data dependency. Responsible data stewardship is critical.
Looking beyond the blind spots to get the whole claims picture
Missing details can be key to settling insurance claims. What insurers don’t know can definitely hurt them.
All about timing: The importance of discovery triggers in cyber insurance
ISO’s commercial cyber insurance program—designed specifically for small and midsized enterprises (SMEs)—includes a unique feature: a discovery trigger applicable to…
ISO survey: Data breach risk is top of mind for many insurers
It seems not a day goes by without a cyber breach reported somewhere around the globe. Insurers are thinking about cybersecurity too, if the past five ISO Emerging Issues…