Insurance Services Office and the National Insurance Crime Bureau (NICB) said today they are collaborating to develop new antifraud tools for insurers' special investigations units.
A new SIU Case Manager (SCM) platform integrating many functions associated with managing underwriting and claim investigations will be available to insurance carriers this year, said Jersey City, N.J.-based ISO.
The new platform provides workflow automation required by SIU professionals. NICB, based in Palos Hills, Ill., is a nonprofit organization dedicated to preventing, detecting and defeating insurance fraud and vehicle theft.
"SIU Case Manager will help investigators document, assign, report and archive claims being investigated," said the ISO announcement. "It will include a customer response diary, expense tracking, time-triggered mailings, and streamlined NICB and state fraud bureau reporting features for enhanced SIU productivity."
SCM will be integrated with ISO ClaimSearch, a comprehensive all-claims system, and ClaimDirector, a claim-scoring service. SCM will also assist insurers with enterprise-level reporting and compliance with regulatory requirements for antifraud programs, said ISO.
ISO noted that SCM is its latest enhancement to the case-management platform for NICB's use. A "fraud bureau" version of the product, customized for the needs of state insurance fraud investigation agencies, will also be available.
"The process improvements delivered by the SCM platform will benefit company management, SIU staff, underwriters, claim adjusters and policyholders," said Vincent Cialdella, vice president of ISO ClaimSearch. "In addition to improved fraud-activity reporting capability and compliance, it will enable SIU personnel to be more productive and efficient in investigating potentially suspect claims."
In a related announcement, ISO said it is developing a specialized version of its NetMap for Claims data-analysis and visualization software tool for the NICB. It will allow NICB investigators to perform customized searches using the ISO ClaimSearch database, helping them to identify organized fraud rings and collusion-oriented fraud activity.
Supplementing its current access methods to questionable claims referred by insurers, the NICB will also offer state fraud bureaus a new Web-based version of its Referral Review system, the ISO announcement said.
The Web-based system will provide fraud bureaus with instant access to questionable claims via ISO ClaimSearch and allow them to pass that information to their own systems electronically or via the SIU Case Manager platform.
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