AI

Analytics at Work in Detecting Insurance Fraud

With analytic techniques such as business rules, statistical models, and machine learning it can be difficult to understand the role of each approach in identifying fraud. Analytical techniques used in identifying fraud There are a variety of techniques that are used to detect fraud, many of which fall under the umbrella of business rules, statistical […]

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Claims data quality critical for analyzing insurance fraud

As the old saying goes “garbage in, garbage out.” Applying this mentality regarding the quality of the data is critical when building fraud risk detection systems.  While it may seem like a no-brainer, the characteristics of typical insurance data increase the requirement to perform basic data hygiene before any analytics can be executed. A critical […]

AI

Delivering effective analytics with limited or no ground truth

Insurance companies are continually subjected to questionable claims, whether that be actual fraud, waste, or just abuse. Insurance fraud in the U.S. alone represents a USD 32 billion in P&C and USD 84 billion in health care costs per year loss to insurance companies. Each carrier has tens and even hundreds of thousands of claims processed, yet […]

Analytics at Work in Detecting Insurance Fraud

With analytic techniques such as business rules, statistical models, and machine learning it can be difficult to understand the role of each approach in identifying fraud. Analytical techniques used in identifying fraud There are a variety of techniques that are used to detect fraud, many of which fall under the umbrella of business rules, statistical […]

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IDC ranks IBM #1 FinTech in Top 25 Enterprise category for fourth consecutive year

Based on its research and market analysis, IDC Financial Insights announced its annual FinTech Rankings 2020, recently, in two categories – The IDC FinTech Rankings Top 100 and Top 25 Enterprise. We’re proud to share that IBM is identified #1 FinTech in the Top 25 Enterprise category for the fourth consecutive year in the annual […]

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Claims data quality critical for analyzing insurance fraud

As the old saying goes “garbage in, garbage out.” Applying this mentality regarding the quality of the data is critical when building fraud risk detection systems.  While it may seem like a no-brainer, the characteristics of typical insurance data increase the requirement to perform basic data hygiene before any analytics can be executed. A critical […]

Continue reading

Delivering effective analytics with limited or no ground truth

Insurance companies are continually subjected to questionable claims, whether that be actual fraud, waste, or just abuse. Insurance fraud in the U.S. alone represents a USD 32 billion in P&C and USD 84 billion in health care costs per year loss to insurance companies. Each carrier has tens and even hundreds of thousands of claims processed, yet […]

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The importance of analytic insights for claims fraud prevention

149, 542, 782, 974 . . . what do those numbers mean to a claims handler or to an investigator? When analytics programs evaluate claims and/or other insurance objects such as policy holders, body shops, providers, etc., the analytics generate a score to reflect the level of risk of the evaluated objects. That score is […]

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Top 5 takeaways from the digital compliant client lifecycle journeys webinar

The pressure on financial institutions to become more efficient, comply with new regulations, and compete with novel technologies and entrants is growing. Financial firms are looking at uncertain conditions due to COVID-19, as well as related increases in financial crime and fraud. The IBM Customer Lifecycle Management (IBM CLM) with Fenergo solution is designed to […]

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IBM Safer Payments recognized as ”Fraud detection and prevention product of the year”

On its 25th anniversary, Risk.net Asia recognized IBM Safer Payments as “Fraud detection and prevention product of the year.” This recognition is a testament to the IBM RegTech team’s commitment to bringing next generation risk and compliance solutions to serve clients across the globe and also to meeting geo-specific industry and business needs. IBM Safer Payments […]

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IBM Financial Transaction Manager announces ISO 20022-ready High Value Payments offering

New high value payments solution offering IBM Financial Transaction Manager (FTM) has announced its new High Value Payment (HVP) offering. This new HVP offering supports banking clients participating in new real-time gross settlement systems in Europe such as Target2 migration to ISO 20022 by end of 2021. Over 3,000 financial institutions worldwide offering SWIFT cross-border […]

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Powering digital compliant client lifecycle journeys with artificial intelligence

Digital transformation trend is ramping up The COVID-19 pandemic outbreak, over the last few months, has significantly impacted financial institutions and organizations across the globe. The FIs have been propelled into a new world of managing and serving customers. Digital transformation is ramping up with an immediate requirement to provide digital remote account opening and […]

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How to stay ahead of insurance fraud in the new normal: 6 analytics techniques to monitor claims data changes

Introduction IBM has sponsored two virtual roundtable conversations where industry experts share views, examples and tips on the impact of COVID-19 on insurance fraud. If you haven’t seen them, you can catch the replays on demand at COVID-19: Responding to the threat of fraudulent claims and How can the Insurance Fraud Industry stay ahead of […]

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Announcing new capabilities in Financial Crimes Insight for Claims Fraud 6.5.1

Financial Crimes Insight for Claims Fraud 6.5.1 release On June 19th, 2020, IBM released Financial Crimes Insight for Claims Fraud 6.5.1. This release is the result of approximately an 8-month design partnership with an insurance carrier in the U.S., delivering many significant updates. The Financial Crimes Insight for Claims Fraud solution is designed to help […]

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