How to Catch Fraud Before You Pay the Claim

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January 2nd, 2018

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aiInsurers catch most instances of fraud after they already paid for the claim. However, it is harder to get money back from a fraudulent claim than it is to prevent fraud in the first place. This was not always the case. With the rise of powerful analytics, insurers can use the data to make predictive models. These models can trigger an investigation into a claim if it contains markers of previous cases of fraud. This will allow insurers to stop fraud before paying the claim.

How Data Models Work

Data analytics are not new, but insurers had not been able to use them to their full potential until now. Statistical modeling and machine learning were not readily available in the past, but the technology has made significant strides in recent years. For example, an insurance agent could always survey claims data and try to draw conclusions. However, this method would prove too slow and too prone to error to be reliable.
With machine learning, the insurance agent presents the machine with sets of data (in this instance, true claims and fraudulent ones). The machine then learns over time how to develop insights into these sets of information. The machine can then use this knowledge and apply it to new claims. Through this method, the machine can interpret with reliable accuracy if a claim is high risk of being fraudulent.

Catching Fraud During FNOL

It is best to identify fraud during or right after first notice of loss (FNOL). This is because each step after FNOL is investigative or communicative. It is easier to look for fraud at the outset of the claim than to go back after the fact and try to find the relevant information.
Internal and external data are both relevant for fraud detection. Internal data, the information insurance agents collect, can provide common fraud statistics. However, external data is just as important for statistical modeling. This includes information such as regional demographics or weather conditions during the time of the loss. All of this data combined creates one premier set of data to use for predictive modeling.
Fraud is not the cost of doing business—at least not anymore. Fraud detection and prevention will always be a crucial element to claims management, but, with new technology, insurers can simplify and expedite the process. They can even identify fraud before they pay the claim. To learn more about claims management and fraud prevention, contact the experts at Actec.

Employee Absence and Fraud Prevention Through Call Center Services

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November 18th, 2014

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Don’t let employee absences slow down your organization. As soon as an employee reports an absence, there are many steps to be taken. Automatic notification of all affected parties, activation of procedures to find a replacement, and beginning the intake process for absences related to short-term disability, long-term disability, or Family Medical Leave Act (FMLA) incidents are all crucial elements. Beyond this, Actec also records when the absence will begin and when the employee will return so you can plan accordingly, all without consuming your supervisors’ valuable time.

It’s equally critical to stay connected with feedback from your employees regarding fraud, theft, sexual harassment, ethical concerns, equipment breakdowns, and safety matters to eliminate potential problems before they evolve into serious liability issues and lawsuits. Proactively soliciting feedback from your employees not only reduces your liability, but it also increases retention and improves the working environment for all of your employees and keeps you in compliance with the Sarbanes-Oxley Act of 2002, which mandates that companies provide a way for employees to submit anonymous reports about financial irregularities without fear of retaliation.

Key Terms in FNOL & Absence Management

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March 6th, 2013

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First notice of loss and absence management programs present a substantial opportunity for organizations to improve efficiency, decrease shrink, and increase the bottom line. The basic concepts of FNOL and absence management are simple enough, but it doesn’t take long to get bogged down in dense terminology and jargon. In this blog we’ll lay out some of the most important terms.

Incident Reporting – The process of transferring data from the initial instance of contact into a working claims document.

Workflow changes – Modifications to documentation and procedure based on new requirements set forth by legislation or corporate shifts in policy.

Intake Specialists – Personnel trained in first notice of loss and incident reporting procedures.

Claims Management – Processing incident reports to resolve necessary documentation, compensation, and other issues arising in the FNOL and absence management process.

Fraud Prevention and Absence Management Via Outsourced Call Centers

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June 6th, 2011

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Unmanaged employee absences can grind an organization to a halt. As soon as an employee reports an absence, many steps must be taken. Automatic notification of all affected parties, activation of replacement procedures, and the intake process for absences related to short-term disability, long-term disability, or Family Medical Leave Act (FMLA) incidents are all pivotal in unfettered operation. Beyond these necessary and basic requirements, Actec also records the intended beginning and completion of the absence so you can plan accordingly, all without consuming your supervisors’ valuable time. Another equally critical component is to stay connected with feedback from your employees regarding fraud, theft, sexual harassment, ethical concerns, equipment breakdowns, and safety matters to eliminate potential problems before they evolve into serious liability issues and lawsuits. Soliciting such feedback from your employees not only reduces your liability, but it also increases retention and improves the working environment for all of your employees as it makes them better appreciate the important role they play in the communication cycle. It also keeps organizations in compliance with the Sarbanes-Oxley Act of 2002, which mandates that companies provide a way for employees to submit anonymous reports about financial irregularities without fear of retaliation. Going without an expert outsourced call center can have a devastating long-term impact on a company’s future. Without FNOL, organization and loss mitigation technologies, things fall through the cracks.