实例探究 > Erie Insurance Improves Its Detection Process and Stays True to Its Values with LexisNexis® FraudFocus Enhanced

Erie Insurance Improves Its Detection Process and Stays True to Its Values with LexisNexis® FraudFocus Enhanced

公司规模

1,000+

地区

America

国家

United States

产品

LexisNexis FraudFocus Enhanced
LexisNexis Accurint

技术栈

Predictive Modeling
Data Analytics
Linking Technology

实施规模

Enterprise-wide Deployment

影响指标

Cost Savings
Customer Satisfaction
Productivity Improvements

技术

分析与建模 - 预测分析
应用基础设施与中间件 - 数据交换与集成
应用基础设施与中间件 - 数据可视化

适用行业

金融与保险

适用功能

商业运营
质量保证

用例

欺诈识别

服务

数据科学服务
系统集成

关于客户

Erie Insurance is a long-time client of LexisNexis, offering auto, home, business, and life insurance through a network of 2100 agencies in 11 states and the District of Columbia. One of Erie’s founding goals is to deliver the highest levels of protection and service at the lowest possible price. To meet this goal, Erie has adopted superior fraud detection tools from LexisNexis. The company has a strong commitment to its core values of honesty, fairness, and good stewardship of customers’ and investors’ funds. Erie has been a pioneer in implementing advanced fraud detection technologies, working closely with LexisNexis to integrate and evolve these solutions over time.

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挑战

Insurance industry studies indicate that 10 percent or more of property/casualty insurance claims are fraudulent, according to the National Insurance Crime Bureau (NICB), and fraud is the second most costly white-collar crime in America behind tax evasion. Added up, the NICB notes, insurance fraud costs Americans billions of dollars each year. For nearly a decade, Erie has managed its share of fraudulent claims with the help of the automated LexisNexis® FraudFocus™ platform, which uses predictive modeling and other tools to analyze claims information for patterns of fraud probability. In fact, Erie was a pioneer in implementing LexisNexis FraudFocus, being one of the first users of its unique predictive modeling technology in the insurance claims market. The result was a long-standing relationship in which the two companies have worked closely together as the fraud detection platform has evolved – most recently to include public records.

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解决方案

The latest iteration of the platform, FraudFocus Enhanced, incorporates data, linking technology, and analytics to provide intelligent information throughout the life of a claim, with the aim of delivering optimal fraud detection. Significantly, it builds on the power of its predecessor with the integration of an unparalleled store of LexisNexis public records into the process, automatically incorporating data such as criminal and financial distress reports. FraudFocus Enhanced intelligently interprets the information in LexisNexis® Accurint®, a direct connection to more than 34 billion current public records for use in detecting fraud, verifying identities, and conducting investigations. This depth of information eliminates reliance on suppositions, replacing them with a flexible alert platform as determined by the user. Incorporating both external and internal data with close adherence to business rules, FraudFocus Enhanced delivers the right piece of information at the right point in the process for effective resolution. The platform also provides a showcase for LexisNexis core competencies: its wealth of information, its understanding of the impact of that data on the claims process, and its expertise in delivering it.

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运营影响

Enhanced review: The predictive analytics that drive FraudFocus Enhanced serve to 'level the playing field for adjusters in the review of claims and pursuit of fraud,' according to Erie. The solution fills any gaps in experience and honed intuition between seasoned and less seasoned adjusters, with alerts that spur a closer look. The program also helps sharpen adjusters’ skills over time, as they learn what to look for from the information FraudFocus Enhanced provides.
Equal treatment: With FraudFocus Enhanced, claims of all sizes and types are subjected to the same treatment. This means improved efficiency through a tighter screen that keeps smaller, more routine cases from being overlooked or given less scrutiny than larger, more complex claims.
Fairness through consistency: As Erie’s corporate values revolve around 'doing the right thing,' benefits such as quality investigations and equal scrutiny of claims are important. So is the consistency FraudFocus Enhanced brings to the process. Its intelligent use of information and predictive analytics means 'fairness across the board' at Erie. The automated program creates alerts based solely on facts in a claim, minimizing the possibility of overlooking relevant and important information, while providing a sound foundation for investigation and pursuit of fraud.
Constant awareness: FraudFocus Enhanced also ensures there is always a focus on fraud detection, Erie executives say, giving exposure to information that should be given attention and minimizing missed opportunities.
Time management: FraudFocus Enhanced not only provides alerts to possible fraud, it also helps adjusters 'understand what the depth of investigation should be,' according to Erie. It also facilitates efficient workflow and optimizes resources by allowing sound prioritization to be made so adjusters can know they are 'looking at the right claims.' In addition, the improved quality of referrals Erie has achieved with the FraudFocus Enhanced platform helps ensure that the adjusters make the most effective use of their time.

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数量效益

In total, insurance fraud costs more than $96.8 billion a year.
Conservative estimates place the cost of property/casualty insurance fraud at $20 billion a year.
Health insurance fraud estimates top $61 billion a year.
Life insurance fraud exceeds $11.8 billion a year.
Auto physical damage fraud reaches about $3 billion a year.

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