financial crimes

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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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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How GRC sustainability can help support cost efficiency

Sustainability and resilience are about how an organization designs and carries out strategies that can be adaptable to help address long-term global trends, crises, threats, changing regulations or customer needs. As the requirements for success change, so can the enterprise. In this current pandemic many organizations should ask business continuity questions about capacity, bandwidth and […]

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IBM RegTech hosts risk and compliance thought leaders at virtual summit

The COVID-19 pandemic is one of those rare civilizational disruptions that is profoundly affecting nearly all human institutions. Organizations are scrambling to respond to threats to the health and safety of their stakeholders, and to grapple with new constraints and shifting realities in this crisis. While the human toll of the pandemic is unequivocally a […]

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2019: An artificial intelligence-enhanced AML odyssey

Welcome to the brave new world of artificial intelligence-powered regulatory technology. On December 3, 2018, the Board of Governors of the Federal Reserve System, the Federal Deposit Insurance Corporation, the Financial Crimes Enforcement Network (FinCEN), the National Credit Union Administration, and the Office of the Comptroller of the Currency issued a joint statement encouraging the use […]

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Financial crime in finance: Unlocking communications to find hidden risks

FINRA and other regulators have informed firms of their expectation to adopt practices of “heightened supervision” to isolate high-risk brokers and activities, including those who have previously committed financial crimes. In the past two years, FINRA has released guidance to strengthen controls on high-risk brokers and further indicated it would be an ongoing priority. In […]

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Three fundamental shifts in financial crime investigations

Financial institutions globally are awakening to the fact that regulatory technology will drive the next wave of innovation in their approaches to understanding and stopping financial crimes. From attempted money laundering, to account takeover, to insider trading, institutions are paying attention. But for some in the financial industry, the idea that these technologies can solve […]

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Ending vicious AML cycles: Why repeating the same approach is no longer sustainable

In 2010, I was traveling with my son, when his name was flagged for a partial match to a suspicious person by the US Transportation Security Administration (TSA). The TSA agent, dutifully asked if he could have a word with my son to sort out this issue, to which I replied, “Be my guest.” My […]

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Balancing customer expectations (and risks) in real-time payments

Riddle me this? Would you rather travel from New York to Los Angeles, hyperloop style, in half the time of flying, knowing that your safety is not assured, or sit aboard a conventional flight for 7 hours, knowing that you have chosen a statistically safer, though significantly slower, means of travel. Consumers are almost unanimously […]

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