Fraud Investigation

Automatically detect existing and uncover previously unknown cases of fraud in order to reduce exposure to organised and opportunistic fraud. Gain a complete picture of the types of connections amongst subjects across all lines of business.

Impact of insurance fraud

Insurance fraud has risen dramatically in the last years and this trend looks likely to continue due to the effects of financial stress and increased living costs, driven by the economic climate. Insurers are committed to protecting honest policyholders from the cost of fraud, whilst providing customers with the highest levels of claims service.
Effective investigation is an essential part of the claims process, allowing insurers to detect and manage fraud, save money and reduce the cost of premiums. Insurers face an ever increasing requirement to provide excellent customer service, manage total claim costs, reduce the lifecycle of claims and meet claimants’ legitimate expectations. Speed is of the essence in order that honest policyholders have a positive customer experience and are reinstated swiftly. However, whilst it is important that claims are validated quickly, it is also essential that the validation process is undertaken properly, to ensure that the premium pool, which is funded by all policyholders, is not depleted by fraudulent activities. Effective investigation and the delivery of an excellent customer service need not be mutually exclusive.

Detecting claims insurance fraud

Nowadays insurers can use technology and counter-fraud intelligence services to speed up investigations, delivering operational efficiencies and reducing the time taken to collect and integrate key information. Investigation management systems can assist insurers with mitigating risk and optimising their counter fraud resources most effectively. Tools can complement existing anti-fraud strategies and now provide insurers with a single point of access, real time, to extensive consumer intelligence. Systems and workflow processes can be streamlined to create an immediate profile of a customer, together with their claims history and provide insurers with a consolidated view of the risk and potential areas requiring further investigation. Certainly the market as a whole recognises the potential reputational risk linked to claims fraud investigation.
The insurance market recognises that increased co-operation, joined up thinking and a collaborative approach to the management of fraud is vital to staying one step ahead of the fraudsters. Insurers promote their position on fraud to varying degrees. A ‘zero tolerance to fraud’ reinforced at individual insurer level would act as a strong deterrent to ‘would be’ opportunists and organised fraudsters.

Sherlock

​Sherlock is designed to deliver, in one click, counter-fraud intelligence to the investigator. By consolidating best of breed data sets on a single screen, Sherlock supports around 100 UK insurers in speeding up the investigation process, delivering operational efficiencies, and reducing the time to collect and integrate key information.