Innovative software solution: At the IASIU conference, INFORM shows innovative ways of combating insurance fraud – cooperation between specialized software and human expert knowledge the sure-fire key to recognizing fraudulent claims.

INFORM GmbH Aachen, provider of intelligent decision-making software solutions, has, within the scope of the Fifth International IASIU Conference (International Association of Special Investigation Units) in June 2010 in Bad Kreuznach, shown ways in which insurance claim notifications can be processed efficiently and fraudulent recognized. In Germany alone, yearly damages from insurance fraud amount to around four billion Euros. In his speech, given to numerous experts from the insurance field, Konrad Hochmuth, Senior Fraud Expert at INFORM, presented above all the importance of cooperation between specialized software and human expert knowledge in the sure-fire defense against fraudulent claims. An ideal outcome of this interaction is reached using software based on Fuzzy Logic technology. As a worldwide organisation with over 4,000 members, the IASIU is one of the most important organisations in the sphere of combating insurance fraud. The yearly conference is one of the most renowned events in the field of insurance. Leading experts exchange information on the newest developments in the fight against insurance fraud. In this realm, INFORM offers the software solution Risk Shield, which, with over 30 different implementations, is one of the leading systems on the market used by international insurance companies.

In his speech, Konrad Hochmuth made it clear that the implementation of software alone is not enough to effectively fight fraud. “In fact, a leading insurance company should have a clear idea of what type of strategy they wish to use for detecting fraud. A good software solution can then be individually adapted to the corresponding procedures of an insurance policy.” Because of his more than ten years of experience in the development of fraud detection software, Hochmuth is also aware of the importance of human experts in combating fraud: “Fraud detection software is able to indicate a potential attempt to commit fraud on the basis of data on the insured party and the reported damages.” To do this, the software evaluates the data available with the help of predefined rules. “Fuzzy Logic technology has proven to be particularly suited to the creation of accurate rules. Through this technology, expert knowledge is implemented optimally and avoids a too high false positive rate.” In this way, insurance companies can process claims, which have been classified as unsuspicious, quickly and cost-effectively. The fraud experts, on the other hand, focus completely on the handling of all the claims classified as suspictious. Whether suspected fraud actually is fraud, is reserved for their judgement. “There is, after all, data which cannot be evaluated by software.” Among such data is, for example, the picture of the site of an accident, which, under certain circumstances, can substantiate or dispel a suspicious case.

Furthermore, the participants at the conference also discussed the impact of the financial and economic crisis on the claims handling process. Automated procedures in the claims handling process and the reliable detection of fraudulent claims are enormously important for insurance companies in order to continue being economically successful in times of crisis. “Here, a good software solution can be of assistance, not only in detecting fraud, but also in making the claims handling process more efficient from beginning to end,” says Hochmuth. In this way, competing in-house goals can be unified. “On the one hand, costs arising from claims for damages and their processing are reduced. On the other hand, the quality of service and the company’s appeal to new clients both increase.”

INFORM specializes in software for the optimisation of complex business processes based on Operations Research and Fuzzy Logic. INFORM software makes its own intelligent decisions in real time in the field of fighting fraud in banks, insurance and telecommunications companies. Furthermore, INFORM optimizes business processes in transport logistics, airport resource management, manufacturing and materials management. INFORM’s more than 350 employees look after numerous clients all around the world, including financial service providers, insurance companies, passenger airports, industrial firms, storage and handling centres and transport companies.

With RiskShield, INFORM offers one of the leading systems on the market for claims assessment at insurance companies. RiskShield decision components have been implemented in more than 30 insurance portfolios in Europe and North America for automatic claim evaluation and fraud risk assessment. In Germany alone, 40% of all reported car insurance claims are assessed using RiskShield. As a rule-based expert system, the software fully assesses the risk of fraud for a reported insurance claim automatically. Here, the system works in a way similar to a human expert: The risk of fraud is classified according to years of experience of human fraud experts. In doing so, the system takes into consideration both incriminating and exonerating characteristics.

Presscontact
INFORM GmbH
Sabine Walter
Pascalstraße 23
52076 Aachen
Germany
Phone: +49 2408 9456-1233
Fax: +49 2408 6090
eMail: sabine.walter@inform-ac.com

This release was published on openPR.