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Tech triumphs in fight against fraud How technology is helping the insurance industry solve a pernicious problem

where opportunistic fraud is happening.” SAS’ Fraud Framework for Insurance is a popular piece of software among American insurers. It has the ability to detect, prevent and manage fraud across all lines of business by processing data through advanced analytics models. A key strength of the program is the interfaces it uses to visualize fraudulent alerts and explain them in simple terms, Hartley says.

“Technology and data analytics can help with fraud detection by looking for things that people can’t see”

Insurance fraud is an ugly beast. It has complex layers and the ability to morph and contort, making it difficult to detect. Around 10% of personal lines insurance claims contain fraudulent elements, costing the property & casualty industry up to $40 billion a year in the US alone, according to SAS. It’s a plague that reaches right down to individual policyholders, who bear the burden of higher premiums as a result of fraudulent claims. But there are companies making


headway in the fight against fraud, particularly in the technology and software sectors. “Technology and data analytics can help with fraud detection by looking for things that people can’t see,” says David Hartley, director of insurance solutions at SAS. “It can spot anomalies and outlines, and flag them up for a real person to review for potential fraudulent activity. Data analytics can be run at a number of levels. It’s now possible to highlight individuals, households or even particular ZIP codes

Nationwide to pump $100 million into insurance startups

Nationwide has announced that it will invest $100 million in tech startups in the areas of retirement planning, insurance and financial services, and consumer information protection. To date, the insurance company has made investments in six startups, including Next Insurance, Insurify and Bloom. Nationwide has also established Refinery 191, a business incubator that helps identify trends in financial and insurance services, and collaborates with other companies on initiatives.


Detecting insurance fraud is likely to get even more difficult as digitalization booms in the insurance industry. Data analytics and fraud exposure software can enable realtime detection of suspicious activity in the always-on insurance world. “It’s much easier to lie to a website than it is to lie to a human being,” Hartley says. “Digitalization could potentially make it easier for fraudsters to make bogus applications, manipulate the system and invent claims. Insurance companies need to be reviewing their fraud-detection models every six months because fraud typologies change. They also need an analytical platform that allows them to sandbox data to be able to look for new emerging trends.”

Aetna reportedly in partnership talks with Apple

Insurance giant Aetna has reportedly held secret meetings with technology titan Apple to discuss a partnership that would provide either free or discounted Apple Watches as perks for the insurer’s customers. People close to the matter told CNBC that executives from Aetna and Apple, as well as hospital chief medical information officers from across America, attended the meetings in Southern California. Aetna’s supposed timeline for the collaboration to launch is early next year.

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Insurance Business America issue 5.09  

The magazine for America’s insurance broking and advice community.