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FICO Debuts New Fraud-Fighting Solution

The FICO Claims Fraud Solution detects and prioritizes fraud incidents using predictive models, business rules and link analysis.

FICO (Minneapolis) has announced the availability of a new solution aimed at fighting insurance claims fraud. The FICO Claims Fraud Solution uses what the vendor describes as three integrated technologies — predictive models, business rules and link analysis — to identify more fraudulent insurance claims faster, in order to help insurers cut general insurance fraud losses.

The FICO Claims Fraud Solution uses predictive models based on neural networks, modeled after the human brain. These models identify potential fraud either at the point of sale or at first notice of loss, so that insurers can catch fraud before the claim is paid, FICO asserts. The results are prioritized so that investigation actions are more efficient, focusing most on those claims most likely to be fraud.

[For more on anti-fraud technology see Canadian Insurers Use Technology to Battle Cross-Border No-Fault Fraud.]

Fraud investigators can use FICO's business rules management system to identify suspicious claims that match known fraud schemes, according to the vendor. With the solution's link analysis capabilities, fraud investigators can scour claims data to find previously undetected fraud based on connections to confirmed fraud cases found by the business rules or FICO analytics. This technique is particularly useful for uncovering fraud rings, such as "cash for crash" auto fraud schemes where criminals cause collisions with innocent drivers in order to file fraudulent whiplash and other claims, FICO says. The combination of predictive analytics, link analysis and business rules finds up to 50 percent more fraud over a rules-based system alone, the vendor claims.

"Personal lines and commercial lines claims deserve the same vigilance that insurers are already applying to healthcare insurance fraud, waste and abuse," comments Russ Schreiber, VP and insurance practice leader at FICO. "FICO has been the leader in analytics-based fraud detection over the last 20 years, and we're applying our advanced analytic approach to give personal lines insurers the most powerful protection on the market."

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio

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