Great American Insurance Companies ($6.5 billion in assets, Cincinnati) historically had a manual approach to detecting claims fraud. Not only was it eating up hours of work, manual detection was causing a loss of precious time in the turnaround of legitimate claims. And although Great American's adjusters are trained to know fraud when they see it, according to Jim Dowdee, senior vice president, they don't always see it.
"We had search capability but we had to search external databases for the information," says Dowdee. "Fraud rings are always very careful to hide their identity. They use a lot of different addresses and information that from claim to claim might not look suspicious. It was a time-consuming process."
Dowdee and his colleagues also believed a more efficient fraud solution would act as a superior fraud deterrent. "Over the years, it has been determined that fraud rings will avoid companies that have outside adjustors, special investigative units and expert tools," says Dowdee.
Last year, Dowdee relates, a team of special investigative unit (SIU) experts sought companies that would best meet Great American's goal of greater efficiency. Ease of use and implementation also factored into the team's analysis of vendors and its eventual selection of Jersey City, NJ-based ISO's Claim Search ViewLink Manager, which compares fields from individual claims and identifies similarities.
No platform changes were necessary for the implementation of ViewLink Manager. "Although the process to determine the best product took a while, once it was licensed, we were using the ViewLink Manager very quickly," says Dowdee.
Training was provided by ISO for Great American's SIU. Members of the unit were trained on how to query the system, which allows users to search a number of databasesincluding ISO's, which has 140 million claims records, according to Dowdee. "ViewLink Manager brings information to you in a graphic form," he says. "It reveals hidden connections in claims data. I think that it provides and enables more thorough investigations of potentially fraudulent claims."
Great American has been using ViewLink Manager for five months and has already begun to realize some of its goals. "We've been able to detect some activity that would have taken us a long time to determine," says Dowdee. "In the past we had to search external databases manually. ISO's ViewLink Manager brings a commonality to all of the searches. If a particular person is registered under four or five different addresses and five or six different cars we can identify them much more quickly. In the past such a process would have taken hours."
According to Dowdee, no unpleasant surprises came along with ViewLink Manager's implementation. The only unanticipated result was the speed at which Great American's goals have been realized. "We didn't anticipate that we would be able to see benefits from the product in this short a time," says Dowdee. "It allows us to pay our legitimate claims quickly. We've also found significant cuts in costs of investigating suspicious claims. It allows us to fingertip analyze information in 15 minutes. We are finding things that we might have seen in the past with a manual search process, but it would have taken us much longer."
With all of the time saved, more attention can be focused on legitimate claims. "We have already been able to see, through the use of this product, that we are able to pay legitimate claims more quickly," says Dowdee. "Not only does it cut the time, but also the cost of claims investigations."
Looking back, Dowdee's only regret is not investing in the tool sooner. "We know that fraud is a $20 billion industry and it's on the rise, and we think that this is a great opportunity to combat that," he says.
Great American plans to roll out View- Link Manager to other areas of the company. "Eventually we would like to have ViewLink Manager as a virtual piece of our adjusters' workstations," Dowdee reports. "Today, it is mostly our special investigators that are using it. We plan to roll this out to our adjusters over the next year."
Case Study Coseup
Great American Insurance Co., Cincinnati, $6.5 billion in assets.
LINES OF BUSINESS
Private passenger auto, specialty, private and P&C insurance businesses.
ISO's Claim Search ViewLink Manager.
Find a more efficient fraud solution to reduce claim cycle time for legitimate claims.