United against insurance fraud


This year, SAS joined the Coalition Against Insurance Fraud (CAIF). Not long ago I had a chance to attend my first CAIF meeting and I was very impressed with what I saw and heard. Fraud continues to be a thorn in the side of the insurance industry. The most recent National Insurance Crime Bureau (NICB) Questionable Claim report suggests that fraud is still on the rise. To make matters worse, a recent Accenture study suggests that poor customer service can actually drive consumers to commit fraud. With all of this bad news, it’s nice to see leaders in the industry coming together to combat this problem.

On a cold day in Baltimore, the Special Investigation Unit (SIU) leaders from a few dozen major US insurance companies were in attendance along with staff from CAIF, NICB, the International Association of Special Investigation Units, the National Association of Insurance Commissioners, and several different vendors who serve the industry. There was lively discussion of legislative developments and public awareness campaigns, the tone of the meeting was serious and the participants were engaged. In fact, with over 85 people in attendance, this was the largest CAIF meeting ever.

What’s on the agenda for next year? A renewed focus on anti-fraud legislation and lobbying in key states like Florida, New York, Michigan and Texas; a ramped-up social media campaign promoting fraud awareness; and several research projects. Personal Injury Protection (PIP) / No-Fault fraud continues to be a hot topic and CAIF Co-Chair Doug Ashbridge commented on effective techniques to combat a growing fraud problem – scams involving wildfire catastrophe claims.

With a growing Global Fraud & Financial Crimes Practice, SAS is committed to helping insurers address fraud exposure. The SAS Fraud Framework is specifically designed to address the fraud risk exposure across multiple lines of business and for multiple scenarios. One of the key benefits of this approach is that one platform can be used to simultaneously manage an effective fraud detection program for all lines of business and still be nimble enough to deploy new fraud detection models for emerging issues – like a new catastrophic event.

I look forward to future CAIF meetings and discussing fraud topics with insurers across the industry. What thoughts do you have about insurance fraud and how technology can help companies mitigate this risk? Tell us in the comments.

James Ruotolo is the Principal for Insurance Fraud Solutions at SAS. Connect with him on Twitter or LinkedIn.


About Author

James Ruotolo

Principal for Insurance Fraud Solutions

James Ruotolo is the Principal for Insurance Fraud Solutions in the Global Fraud & Financial Crimes Practice at SAS®. He is responsible for fraud detection and investigation management solutions for the property, casualty, life and disability insurance markets worldwide.

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