IBM RegTech Innovations

Announcing new capabilities in Financial Crimes Insight for Claims Fraud 6.5.1

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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 reduce losses from medical fraud, P&C fraud, motor/auto fraud, etc., by applying cognitive analytics to identify complex and changing fraud patterns.

As part of the Financial Crimes Insight for Claims Fraud 6.5.1 release some of the new capabilities include:

  • An updated data and AI pipeline to more automatically ingest data into FCI,  generate analytic features, and execute the multiple analytic techniques
  • Ready to use supervised and unsupervised machine learning models to detect potential fraud (and even waste and abuse) for a specific claim based on the behavior of involved parties and attributes pertaining directly to the claim
  • Ready to use deterministic rules to act as a final arbitration of the score to ensure, if necessary, assessments are created based on very practical experience or regulatory (internal or external) compliance requirements
  • Entity resolution analytics to identify entities that are trying to conceal their identity as well as non-obvious relationships
  • Graph analytics to review the riskiness of the overall network associated with objects affiliated with the claim
  • Text analytics to comb through the claim notes, claim description, and loss description to look for keywords and expressions
  • Ingestion of watchlist to track known bad actors
  • Integration with 3rd party public records to enrich party records with data about their history and behavior related to financial distress and criminal history

These all aggregate in an overall risk score of the claim that is sent back to the client for ingestion into their claim system for the claims adjuster to consume. Financial Crimes Insight is also making it easier for claims handlers and investigators to understand the composition of the score by providing scoring insights in the form of English phrases.

Deploy on IBM Cloud Pak for Data

The 6.5.1 release is significant as it represents the first production deployment of Financial Crimes Insight for Claims Fraud as a Cloud Pak for Data Cartridge. IBM Cloud Pak® for Data is a fully-integrated data and AI platform that modernizes how businesses collect, organize and analyze data to infuse AI throughout their organizations.

To learn more about IBM Financial Crimes Insight for Claims Fraud visit http://ibm.biz/FCIClaimsfraud

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