In a continuing effort to combat insurance fraud, ISO and the National Insurance Crime Bureau (NICB) have developed new antifraud tools for an insurance carrier's special investigations units (SIU).
The SIU Case Manager (SCM) platform integrates many functions associated with managing underwriting and claim investigations and will be available to insurance carriers this year. The new platform provides workflow automation required by SIU professionals and will help investigators document, assign, report, and archive claims being investigated. 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.
SIU Case Manager will be integrated with ISO ClaimSearch, ISO's all-claims system, and ClaimDirectorSM, the system's claim-scoring service. SCM also will assist insurers with enterprise-level reporting and compliance with regulatory requirements for antifraud programs. The product is ISO's 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 be available, as well.
"The process improvements delivered by the SCM platform will benefit company management, SIU staff, underwriters, claim adjusters, and policyholders," says 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 another initiative, ISO is developing a specialized version of its NetMap for Claims data-analysis and visualization software tool for the NICB. This will allow NICB investigators to perform customized searches using the ISO ClaimSearch database, making it easier for them to identify organized fraud rings and collusion-oriented fraud activity–a growing menace for the industry.
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