123ArticleOnline Logo
Welcome to 123ArticleOnline.com!

ALL >> Insurance >> View Article

Detecting Worker’s Comp Claims Fraud Through Technology

By Author: Nate Rodney
Total Articles: 533

The struggling economy has hit insurers hard and has taken its toll in particular on the workers’ compensation system. In addition to premium abuses by employers, claims fraud and abuse by workers and service providers have produced significant losses. As a result, insurers are constantly seeking new understandings that will allow them to gain a competitive advantage, reduce costs and improve risk management. While there are numerous opportunities to improve processes using traditional business intelligence, new automated core systems are driving a shift particularly in worker’s compensation claims to focus on advanced analytics.

Number of Comp Claims Decrease While Questionable Claims Rise
The National Insurance Crime Bureau (NICB) reported that workers compensation claims that were reported from January 1, 2011, through June 30, 2013 were on the decline. In 2011, 3,349,925 workers’ compensation claims were found in the Insurance Services Office (ISO) Claim Search database. That number decreased to 3,244,679 in 2012, and is likely to decrease further in 2013 – only 1,498,725 claims were received in the first half of this year.

At the same time the number of Questionable Claims (QC) referred to NCIB for workers compensation was 3,474 in 2011 (3.5% of total QC’s) That number increased to 4,460 in 2012—a 28 percent rise when total workers’ compensation QCs accounted for 3.8 percent of the total.  Through the first half of 2013, 2,325 workers’ compensation QCs have been already referred to NICB (3.7 percent of total QCs).

The three top reasons for a Questionable Claim referral remain unchanged in the three year period as: claimant fraud, a prior injury not related to work and malingering.

Improvements in System Functionality and Predictive Analysis
According to a survey conducted by the Aite Group fraudulent claims in all lines are on the rise over the last three years for insurers, with nearly $80 billion in fraudulent claims made each year in the U.S. alone.

In the past, insurers relied heavily on claims adjusters to manually flag suspected fraud situations.

Advancements in mobile solutions and enterprise content management (ECM) solutions however have help insurers to not only speed claims processing and increase client support, but also to spot patterns in data to better detect fraud.

Latest developments in mobile solutions and ECM solutions helped insurers to speed-up claims processing and increase client support and to spot patterns in data detect fraud.

New Core Claims Systems that contain better data quality including detailed text descriptions are able to provide more sophisticated and more automated predictive analytical solutions to help identify potential fraud situations more frequently and with greater accuracy. The shift in focus is no small wonder since Increasing the rate of claims fraud detection, can impact insurance bottom line profitability by as much as 3% to 5%.

The use of industry shared database to leverage claims history can be invaluable in detecting fraud. A thorough analysis of prior claim activity can uncover questionable patterns of behavior including preexistent injuries. The industry claims database has swelled from 147 million claims in 1998 to more than 680 million claims today —a growth of 362 percent. Advanced analytic techniques, such as social network analysis, regression analysis, and text mining, can scrutinize large numbers of claims and their attributes at record speed. Claims systems today can examine huge amounts of data, transform the data into strategic insight, score claim characteristics and identify red flags and patterns of claims. Advanced analytics delivers the power to improve.

JDi Data Corporation has provided insurance claims software since 1992. Our product suite includes JDi Data claims software for property and casualty, medical malpractice, and specialty lines. If you are looking for claims management software, JDi Data can be right choice as it has built a reputation in quality claims management software with special emphasis on complex litigation.

Total Views: 75Word Count: 618See All articles From Author

Insurance Articles

1. How Commodity Trading Tips Can Benefit Your Trade
Author: Santosh Sharma

2. Top Five Ways To Reduce Car Insurance Premiums
Author: Brijesh B.

3. Various Ways By Which Truck Insurance In Las Vegas Provide Suitable Insurance To Customers
Author: Michael McCullough

4. No Deposit Auto Insurance At Lowest Rate Easy To Avail Online In Canada Now
Author: Victor Cano

5. Check How Life Insurance Proves To Be A Life Protector For Non-doms?
Author: Brijesh B.

6. A Brief Guide On Claim Process At Star Health And Allied Insurance
Author: Coverfox Insurance

7. Contact Insurance Agents In Northern California For Best Solutions
Author: mikeheige

8. Which Kind Of Life Insurance Coverage Should You Get
Author: Ross Barkely

9. Why Physical Damage Coverage Is Essential For Car Owners In Us?
Author: InsuranceTrak

10. What To Do When Your Car Insurance Expires?
Author: Nansi Bhardwaj

11. How Can Content Affect The Development Of Insurance Business?
Author: Jaye Williams

12. Choosing The Right Insurance Company
Author: Michael McCullough

13. The Commercial Insurance Northern California Company Offers Best Practices To Safeguard The Clients’
Author: mikeheige

14. Your Two-wheeler Insurance Covers Any Sudden Emergency Expenses
Author: Nansi Bhardwaj

15. How To Generate Health Insurance Leads Of Highest Quality
Author: Iradiusgroup


Login To Account
Login Email:
Password:
Forgot Password?
New User?
Sign Up Newsletter
Email Address: