As fraud schemes continue to mutate and grow in complexity, they present irksome puzzles for even the most talented and knowledgeable SIUs and law enforcement officials. In order to identify sophisticated, large-scale rings and isolated incidents that siphon precious resources from P&C insurers and consumers alike, the average claims professional or investigator must employ a combination of technology and analytical savvy, pairing cutting-edge software tools with imagination and tenacity.

Today, Michelle Bergeron, SIU Analytics Program Manager at Esurance and 2009 recipient of IASIU's “Analyst of the Year” award, advised attendees at the IASIU 26th annual seminar about how to fine-tune their approaches by properly analyzing policy data and sales system information in the workshop titled, “Policy Data: Analyze That.”

The presentation incorporated a meld of lecture and live demonstrations via multiple software tools readily available to analysts. Bergeron kicked off the discussion by sharing techniques used to unravel real pervasive fraud schemes, supplying anecdotal evidence of what works and what may be necessary beyond your modus operandi to aggressively target fraud.

“I've developed a system of taking characteristics of all new policies and analyzing them on a monthly basis,” she explained. “For instance, I gather data for all policies purchased and then check back historically to spot similarities or trends. Let's say you notice that a car just added to policy was on two other policies before (and not registered to the same person). That is questionable. It begs further probing.”

Bergeron added that organized activity has increased in sophistication and that analysts must be attuned to even minute details while ramping up common strategies. “Those committing insurance fraud are using three email addresses now, burner phones, mail drop addresses at UPS stores, all of which can change frequently,” she said, emphasizing the importance of looking for patterns, however subtle they may be.

“We had a group operating in a New York city burrough that would obtain policies mostly with email addresses such as Juan 123 at yahoo; maria 123 at yahoo. Although the emails varied, they patterned the same. So we set up a filter for policies established in the area incorporating the '123' pattern. We could then look to see if policies fit other criteria, such as liability only coverage on an older vehicle. Then we checked the policy for claims, say, 20 days out later on and worked from there.”

A savvy analyst must look beyond ISO and examine the wealth of data gathered internally at one's claims organization or underwriting department. That may very well involve shattering silos between the two and even merging disparate systems to present a unified front against fraudsters. If that sounds intimidating, then Bergeron assures you the extra effort and proactivity will be justified and very likely rewarded with a decline in fraudulent claims and resultant payouts.

“Sure, I hear from people who experience issues related to silos,” Bergeron said. “Because [Esurance] is smaller and so tech-friendly, we have been able to adopt a holistic approach and encourage communication across all departments. The more you can cultivate that rapport—that free flow of information—the better off your SIU and organization will be.”

Other topics of discussion included identifying patterns, the using specific reports, as well as other techniques for insurance company claims professionals and investigators at virtually every level. Bergeron did, however, tailor a healthy portion of the presentation to assisting supervisors and managers.

Esurance's national director joined Bergeron to round out the session with an exploration of the company's homegrown solutions, offering advice about prosecuting fraudsters and positioning your organization for success in fraud deterrence.

Special Reports /

IASIU 2011 Coverage: Fraud Prevention Requires Policy Data Analysis

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