Investigation Management for Insurance: Catch More Fraud More Efficiently

The ability to move beyond fragmented efforts depends in large part upon integrating quality internal and external information in order to identify fraud early. As carriers adopt more innovative and effective fraud-detection solutions in response to the growing threat of fraud, they need equally innovative and powerful investigation management systems to manage the increased volume of complex referrals being generated.

Insurers also require the ability to accurately identify and segment fraudulent activity from legitimate activity in order to improve the productivity of both investigative and detection staff while simultaneously increasing customer service and satisfaction. Most importantly, core insurance processes need to fluidly incorporate investigations; therefore, case management software needs to evolve to investigation management software-a single, dynamic, holistic enterprise repository where all information related to a specific investigation is stored and shared among all authorized users and which incorporates the results of fraud analytics and other investigative tools. This record will include every detail in the entire lifecycle of a potentially fraudulent event, from the moment it is identified through the ultimate resolution, recovery, and closure.

This white paper covers the ways in which insurers are embracing enterprise investigation management technology, describes the characteristics of best-in-class platforms, and concludes with an overview of IBM's approach to enabling insurers to be more effective and efficient with their fraud investigations.