IBM Case Studies A major US insurance company improves online insurance fraud detection

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	A major US insurance company improves online insurance fraud detection IBM

A major US insurance company improves online insurance fraud detection

IBM

Technology Category	Analytics & Modeling - Real Time Analytics Application Infrastructure & Middleware - Data Exchange & Integration
Applicable Industries	Finance & Insurance
Applicable Functions	Procurement
Use Cases	Fraud Detection
Services	Data Science Services
Challenge	The major US insurance company was facing challenges in pinpointing fraud quickly on submitted claims and strengthening prevention methods. With each investigator handling 35 investigations, the business needed to accurately and quickly ingest data from multiple sources, including policy, claims and medical billing data; Insurance Services Office (ISO) data; and public records data from the Thomas Reuters CLEAR database to build links and find relationships among fraudsters and the people and businesses they are related to. In addition to determining whether a claim was legitimate, the company believed that gaining insight into customers before granting them insurance would help prevent fraud. It sought a system to help bolster fraud prevention and detection capabilities. Read More
About Customer	The customer is a major US insurance company headquartered in Chevy Chase, Maryland. The company provides online auto and medical coverage to more than 15 million customers in all 50 states and Puerto Rico. Using a direct-to-market sales model, the organization employs 24,000 people and relies on multiple TV advertising campaigns rather than agent-based sales to generate revenue. The company works hard to prevent and detect auto and medical insurance fraud and prosecute perpetrators. It strives to pay, deny or hold any claim for further investigation in 20 days, as opposed to the industry standard of 30 days. Read More
Solution	The company implemented IBM i2 software in its continued fight to prevent and detect auto and medical insurance fraud. The business purchased multiple licenses for IBM i2 Analyst’s Notebook®, IBM i2 iBridge and IBM i2 Text Chart software, which it uses to ingest reports and data from all sources and quickly transform unstructured data into a clear format. The solution helps the company ingest IP addresses, scanned document references, email addresses, driver’s license information, criminal records, judgments or known fraudulent connection data to link multiple sources and identify relationships that may otherwise remain anonymous. The world-class visualization capabilities of i2 software help the company take hundreds of thousands of data points and highlight repeatable patterns, pinpointing entities involved and associated connections and identifying commonalities that may lead to claim denial. Read More Log in to view content
Contents

Technology Category

Analytics & Modeling - Real Time Analytics

Application Infrastructure & Middleware - Data Exchange & Integration

Applicable Industries

Finance & Insurance

Applicable Functions

Procurement

Use Cases

Fraud Detection

Services

Data Science Services

Challenge

The major US insurance company was facing challenges in pinpointing fraud quickly on submitted claims and strengthening prevention methods. With each investigator handling 35 investigations, the business needed to accurately and quickly ingest data from multiple sources, including policy, claims and medical billing data; Insurance Services Office (ISO) data; and public records data from the Thomas Reuters CLEAR database to build links and find relationships among fraudsters and the people and businesses they are related to. In addition to determining whether a claim was legitimate, the company believed that gaining insight into customers before granting them insurance would help prevent fraud. It sought a system to help bolster fraud prevention and detection capabilities.

About Customer

The customer is a major US insurance company headquartered in Chevy Chase, Maryland. The company provides online auto and medical coverage to more than 15 million customers in all 50 states and Puerto Rico. Using a direct-to-market sales model, the organization employs 24,000 people and relies on multiple TV advertising campaigns rather than agent-based sales to generate revenue. The company works hard to prevent and detect auto and medical insurance fraud and prosecute perpetrators. It strives to pay, deny or hold any claim for further investigation in 20 days, as opposed to the industry standard of 30 days.

Solution

The company implemented IBM i2 software in its continued fight to prevent and detect auto and medical insurance fraud. The business purchased multiple licenses for IBM i2 Analyst’s Notebook®, IBM i2 iBridge and IBM i2 Text Chart software, which it uses to ingest reports and data from all sources and quickly transform unstructured data into a clear format. The solution helps the company ingest IP addresses, scanned document references, email addresses, driver’s license information, criminal records, judgments or known fraudulent connection data to link multiple sources and identify relationships that may otherwise remain anonymous. The world-class visualization capabilities of i2 software help the company take hundreds of thousands of data points and highlight repeatable patterns, pinpointing entities involved and associated connections and identifying commonalities that may lead to claim denial.

Impact #1	The company now quickly discovers repeatable patterns to identify fraudulent claims and save the company and its customers money.
Impact #2	The solution provides stronger fraud protection by assimilating multiple data types.
Impact #3	The solution helps identify hidden or anonymous relationships.

Impact #1

The company now quickly discovers repeatable patterns to identify fraudulent claims and save the company and its customers money.

Impact #2

The solution provides stronger fraud protection by assimilating multiple data types.

Impact #3

The solution helps identify hidden or anonymous relationships.

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Overview

A major US insurance company improves online insurance fraud detection

Operational Impact