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Identifying strategies to win the war against insurance claims fraud

Insurance claims fraud is estimated to cost property and casualty (P&C) insurers $30 billion annually, eroding profit margins and driving up premiums for many consumers. With losses mounting from fraudulent claims, fraud management has moved higher on the agenda of senior management. An integrated fraud management program, with an end-to-end vision of the fraud management process, can make a big difference in the ongoing war against fraud.

Creating an integrated fraud management program

Insurance claims fraud is estimated to cost property and casualty (P&C) insurers $30 billion annually, eroding profit margins and driving up premiums for many consumers. With losses mounting from fraudulent claims, fraud management has moved higher on the agenda of senior management.

Many companies have taken steps to improve their ability to identify and address fraudulent claims, but these efforts have typically been fragmented. Effectively addressing claims fraud rests on four pillars of an integrated fraud management program:

  • Develop a fraud management strategy
  • Align the operating model
  • Improve information quality
  • Leverage advanced technology tools and analytics

These four pillars encompass a strategy that clearly articulates fraud management goals; the organizational structure, business processes, and workforce skills required to execute that strategy; the ability to integrate quality internal and external information; and the tools to promptly identify fraud. The ability to move beyond piecemeal efforts and adopt an end-to-end vision of the fraud management process can make a big difference in the ongoing war against fraud.

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Pil Chung

Leader | Actuarial, Risk & Advanced Analytics

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Neal Baumann

Global Sector & US Consulting Leader | Insurance

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