Fraud Defense for our Top Insurer■

Company Overview:

The insurance company ranks 4th in the private sector, selling over four million policies through its branches and various channel partners. They specialize in general insurance, reinsurance claims management, and investment management services. Their market insurance products encompass health, motor, travel, personal accident, home, commercial, and rural insurance.

Major Challenges:

• Revenue leakage from fraudulent claims.
• Lack of mechanism to proactively identify fraudulent characteristics.
• Absence of classification of portfolios for low-risk or high-risk categorization.
• Data lying in silos, hindering the identification of fraudulent claims.
• Longer Turnaround Time resulting in customer loss.

Our Solution & Benefits:

• Integrated data from product, customer, transactional, and behavioural sources.
• Developed a statistical model predicting fraud intensity.
• Classified portfolios into high, medium, and low-risk categories.
• Identified characteristics representing high fraud intensity.
• Automated fraud engine to assign fraud intensity during claim and acquisition.

Products & Services Utilized:

• SAS Enterprise Miner – Design and Development of Predictive Models.
• SAS DI Studio – Data integration from multiple sources.