SIU Today Spring 2018 - 28

*	One area that should not be overlooked by carriers as they
approach this data enriched world of 2018 is the human aspect
of fraud fighting. Many carriers are becoming more aware that
the future of fighting fraud is all about data; data management,
inclusion, and integration, and at the nucleus of this is technology
to help manage this. However, companies, as they focus on
technology, must also remember that they need capable people
to run these systems and fine tune them to meet the demands
of the carrier. I recently read an article about machine learning
which adamantly stated that ML systems are only as good as those
that are driving it. We must embrace technology, but also keep
in mind that we need to include experts to run these systems to
glean the most benefit.

* To be effective in 2018, the claims environment must conduct
an internal inventory and assess how they can leverage data
and technology. The claims structure is one of extremely high
volume, and thus can benefit significantly from leveraging data
management and analytical systems. It is important that the
claims environment is not siloed and working independent of
SIU and other units. Managers must ensure that fraud detection
systems are linked to the claims environment, which will create
a necessary bridge of data. In addition, some fraud detection
solutions can also be utilized in the claims environment. There
are an infinite number of areas within the claim process that
can benefit from optimization; whether it is fast track settlement
routing, workflow management, filling informational gaps with
third party data, and many more areas. Companies desire to
detect fraud in their claims and red-light these cases. However,
in this competitive market, carriers should also focus on taking
care of their honest and loyal customers, by green-lighting them
and processing their claims quickly and efficiently, which can
easily be accomplished using an analytical platform.
*	Carriers that outperform others using data analytics utilize
these systems in a manner that is more global than other carriers.
Customary systems operate in isolated areas, such as SIU, claims,
and underwriting. Successful carriers make sure to avoid this
isolation and take a more holistic approach to fraud detection by
using data analytics in SIU, but also at the point of sale, claims,
underwriting, litigation, and other departments and lines of
business. This will bring more data in the fraud system, data
that will enrich and strengthen the fraud results. This can be
challenging to carriers as traditionally departments don't talk
with one another, but the efforts have been proven to be extremely
invaluable.

28 | SIU TODAY | SPRING 2018

As you start to develop and execute your strategies for 2018,
hopefully these tips will assist with developing a lean and mean
fraud fighting machine!
Dr. Fraud
www.drfraud.org
J. Michael Skiba is an international counter fraud consultant who is currently
consulting with an IASIU supporting partner. He is also a college professor and
is employed as Program Chair of Criminal Justice at Colorado State University
Global Campus. He holds an MBA and a PhD with a concentration on economic
crime and insurance fraud. He can be reached at: michael.skiba@csuglobal.edu
or through www.drfraud.org.
http://www.drfraud.org http://www.drfraud.org
SIU Today Spring 2018

Table of Contents for the Digital Edition of SIU Today Spring 2018
