False Insurance Claims Are Costing U.S. Consumers
Fraud is as old as insurance itself. But with the rise of digitalization, the sophistication of fraudsters has also evolved. In the wake of COVID-19, insurance companies have faced an increase in counterfeit insurance claims, including collusion claims, double claims and phantom claims, according to Forbes: “Some insurance professionals industry believe the number of claims with an element of fraud has nearly doubled since the COVID-19 pandemic.”
Respondents to the FRISS Insurance Fraud Report 2020:
The good news is that while insurance fraud has increased, the use of social media to seek out claims investigations has also increased. If your job is to investigate insurance fraud, this is good news for you. For example, if you can determine that a car accident claim was filed from a so-called vacation destination, while an Instagram status update reveals that the claimant was at a local event, you have a powerful piece of evidence.
The rise of new camera technologies opens up additional possibilities for obtaining evidence of fraudulent behavior. Footage captured by GoPro and similar camera technology shared on social media profiles shows what happened at the time of the crash. This may reveal, for example, that the claimants were not where they claimed to be or that the damage claimed was not as severe as reported.
Social Media Background Data: A Game Changer
Social media background analysis is a growing priority in the digital age. An individual’s social media history can provide excellent context for their behavior and actions in the online world and beyond. This information can reveal malicious activity and speed up investigations.
Social media intelligence offers in-depth insights into users. For example, if an employee submits an insurance claim for a back injury, employers can invalidate the process if they discover conflicting information on social media, such as Instagram photos of the same employee engaged in outdoor sports activities. air.
Additionally, social media filtering can yield valuable information from secondary leads, such as a suspected fraudster’s popular contacts. For example, an injured applicant may appear in a post-marathon photo posted by a loved one.
Accurate intelligence in analyzing social media data
Social discovery delivers trusted, actionable data to customers, earning the trust of leading insurance organizations that enable deep insights for standard claim checks. With an add-on integrated into the
Social Discovery’s data experts have worked with some of the biggest names in the insurance industry. And Social Discovery is the only social media reporting provider for the world’s largest third-party administrator. The company’s analysts offer a unique approach to social media reporting through a hybrid concept called “accurate intelligence”, which combines the precision of advanced AI algorithms with on-the-ground knowledge and contextual interpretation of human experts to deliver relevant data every time. Thus, the revolutionary method of technology avoids false positives that interfere with the success of your operations.
Social Discovery’s dedicated analysts are always ready to support your business with the custom, data-driven solutions you need to fill gaps in your policy management processes. Each solution delivers measurable results through customer satisfaction scores and ROI, providing accurate data that helps streamline the complaints investigation process.
Why social media data is powerful – and how you can harness it
Data from social platforms such as Twitter, Instagram and Meta (formerly known as Facebook) can shed light on illicit activity. Extracting relevant data can be tedious and tedious work for investigators, whose time could be better spent investigating complaints and other customer interactions. Most insurance companies don’t have the necessary tools or developed skills to sift through mountains of information online to expertly extract the most salient points. As a result, experts and Special Investigations Unit (SIU) teams that lack actionable and reliable social media data may miss valuable insights into fraud activity.
Here are some examples of how social media data can be leveraged to uncover fraudulent insurance-related activity:
Personal Injury Claims: In these scenarios, individuals claim a specific injury that results in lasting bodily or mental harm. However, a quick social media search might reveal the falsity of the alleged injury, such as image metadata that shows the individual hiking in the mountains or running a race.
Medical error: These situations involve fraudulent medical insurance claims such as the permanent disability of a child from an early childhood diagnosis. However, the individual may have fully recovered and now live a healthy and healthy life. Accurate social media intelligence can help retrieve the online chat logs between the child’s parent and other accomplices in the cover-up, thus uncovering the fraud.
Workers’ compensation: Social media background analysts can help identify employees who falsely report a work-related accident causing injury or loss of income. For example, analysts may discover that a person claiming complete physical disability resulting from an accident at work is actively offering services as a judo instructor.
Why Traditional Claims Audits Are Sometimes Not Enough
Claims handling is an essential aspect of insurance operations. It also represents high insurance processing costs and has a significant financial impact on the business. Small improvements in claims management can lead to a significant increase in profit margins.
Unfortunately, many claims handlers face a host of challenges that bog down the verification process. For example, managers may spend a lot of time and effort compiling and sifting through multiple sources of data, including information from third-party agencies. The tediously consolidated result could lead to even more questions, claims complications and dead ends.
Additionally, some claims handlers may lack the tools and experience to categorize and prioritize collected user data. Data categorization plays a crucial role in substantiating claims and reducing costs. Manual categorization of applicant information can lead to inconsistencies, inaccuracies, and duplicates, which hinder verification.
Finally, perhaps the root cause of inefficient claims handling is the continued use of legacy systems. Lack of large-scale investment in infrastructure leads insurance companies to stick with less flexible legacy systems, making it increasingly difficult to process claimant data in a rapidly changing digital world .
Key points to remember
Social media investigations can be a valuable tool in virtually any claims investigation process, including workers’ compensation, auto accidents, property damage, and even organized insurance crime.
As the leading provider of social media background reporting, Social Discovery helps SIU departments, adjusters, risk managers, and insurers access the data they need to improve their claims process. examination of complaints.
To learn more about how Social Discovery can help you with your claims investigation process, visit our website and view the Guidewire and Social Discovery webinar, “Claim Fraud – Trends and Triumphs”.