For the last 40 years, the insurance industry, government regulators, and law enforcement agencies have promulgated laws, regulations, and public awareness campaigns about the problem of insurance fraud. The costs of fraud are estimated to be roughly $80 billion annually. Unfortunately, the charges of healthcare fraud are even higher.  Claims Examiners receive training on recognizing typical fraud schemes while processing claims and refer them to their respective SIU for a more in-depth investigation.  Hopefully, the suspicious claims are handled correctly, and law enforcement is notified about the attempted fraud scheme. Unfortunately, the sophisticated fraudsters leverage their strategies against insurance companies by identifying which carriers process claims diligently against those who do not. So how do we slow down and stop the sophisticated rings from stealing hundreds of millions of dollars every year?  Be smarter than them by discovering their presence in your claim’s ecosystem with the help of artificial intelligence before the suspicious claims settle. 

For the business of insurance, you want to use artificial intelligence to mimic the mind of your most accomplished and experienced Claim Examiner. Artificial intelligence is a force multiplier in several things during the claims process. For instance, A.I. can automatically gather external data and enrich it to discover hidden patterns from your claims data never seen before. Machine learning coupled with natural language processing NLP) can significantly augment human intelligence and aid in the decision process in insurance claims.  The natural language processing will identify entities and topics (think of names, businesses, locations, type of loss, and types of injuries) associated with suspected fraud, litigation, and increased severity. In short, this is how artificial intelligence-generated insights develop for claims processing. 

The insurance industry is starting to experience a decline in young workers wanting to start a career with an insurance carrier. In addition, the accomplished senior-level examiners are beginning to retire.  As a result, there will be a significant brain drain in the claims workforce. As a result, claims executives now need to start deploying the right A.I. solution to assist in the claims process.  The Infinilytics’ Charlee™ A.I. solution will bring: 

• Insights for better predictions and decisions early and throughout the claim process  
• Marshal and analyze big data for accurate patterns of behavior, speeding up the identification of suspected fraudulent claims
• Increase the knowledge and power for your examiners in the claims decision-making process
• The enhanced level of a type of cyber supervision for your claims and underwriting teams 
• Train and educate your newer examiner by pointing out red flags and alerts in suspicious claims
• Control and reduce claims severity as well as allocated loss adjustment expense

Contact the Infinilytics Team today to learn more about Charlee™.