Tips to Choose Claims Management Software

 When you make errors while judging, it can become extremely exasperating in the insurance or any business world. Whether these errors you make due to lack of knowledge or your impatient nature, it can cost you high. However, if you want to ensure that you make no such errors and your business functions smoothly then you must consider investing in claims management software for your insurance business.

Of course, while choosing for claim management software you want to settle down for the right one. But, nowadays, there area plethora of systems available. In such a case, how do you know which one is the best fit for your business? Well, do not worry. We have the answer for it.

Let us check out the below tips that you should follow while selecting claims management software

1) Consider Vendor/Company Experience

While selecting the claim management system, the vendor or company’s experience is highly important. It makes sense to go for a company that has experience in developing software related to the insurance field. Therefore, while choosing the software, the first thing you should check for is how long the company has been in the business.

2) Ensure the SoftwareYou Choose is Easy and Intuitive to Use

You should always select the software that is user-friendly and simple. In your insurance business, you have to go through lots of tasks. So, you must pick the software that is easy to learn, normal to use, and captivating to be in. Ensure it is easy to review and operate upon the data.

3) Make Sure the Software is Compatible With Your Insurance Field

You should always select the software that is highly compatible with your specific insurance claims processing field. The company or vendor you are choosing to develop your software must be able to fulfill your entire requirement to handle claims and risks.

4) Choose Cloud-based Software

You should choose cloud-based software for better inter-department communication. It will help them in taking real-time decisions. So, go for SaaS architecture which offers browser-based and state-of-the-art access to your data.

5) Never Compromise on Security

When it comes to managing and processing the claims insurance data, you cannot take any chance. The software you optfor must provide the security you will need to avoid any attempt of a data breach.

6) Emphasize on Cost Efficiency

While choosing the software its reliability and efficiency play an important role but it should not break your bank account. The software you select must also lie within your budget. So, do proper research regarding software costs and ensure there is no hidden cost associated with it. Make yourself well-versed regarding any per-user cost, data storage cost, periodic cost, and much more.

7) The Data Conversion Process Should Go Smoothly

While selecting and buying claim management software, ensure it provides you with the streamlined data conversion. If you face any issue then your vendor or company should be willing to help you in solving it. If you try to fix errors onyour own it will create more problems. So, it is better to involve your vendor or company in the process.

To Sum Up

In nutshell, picking the perfect insurance claims management software might be a daunting task. However, by considering the above tips you can make this task easy for you. It is always better to be safe than feeling sorry and so you should do all the necessary research to ensure you are selecting the right system.

You should go for a highly reputable company like Cogitate - https://www.cogitate.us/ that has extensive experience in easily integrating intelligent claims solutions in your existing CMS. At Cogitate, we help our clients in integrating Cogitate Intelligent Claims solutions seamlessly with their accessible CMS in such a way that it aligns with the demand of their organization. In short, if you want to give your clients the best service possible then ensure the claims management solution that you integrate into your CMS best fit your company needs, has the above-discussed features, and does not end up costing you!

How Insurers Are Using Technology to Deal with Insurance Claims Fraud

 This post details the growing menace of insurance claims fraud. It is a problem that nearly all insurers are battling, but with limited success. The fact that fraudsters are always a step ahead by misusing technology to achieve their nefarious deeds makes it even more difficult to manage the problem. Technology is the only way of mitigating the instances of claims fraud and empowering insurers to deliver their services more effectively.

Insurance claims fraud is an area of serious concern for insurance providers, as the instances of such scams are proliferating globally. Scammers indulge in inflating claims by manipulating facts and making a pile of cash illegally. It forces insurance companies to invest heavily in system upgrades, technology, and manpower to proactively detect such fraud attempts and mitigate potential losses.

The Challenges: 

Insurance providers have been relying primarily on the judgment of agents and industry experts to detect instances of frauds. While this was a reliable method in the past as there were limited number of cases, in the modern world it is impossible to keep a track on fraud using human resources.

• It is virtually impossible to scrutinize all claims manually.
• Fraudsters are using newer and more sophisticated ways of perpetrating such crimes.
• This has entailed the need to use technology to deal with this growing and serious crime.

 

The rise of technology such as data analytics has created a world of endless potential for organizations operating in the insurance sector. While cost concerns and regulations have been the reasons for slow adoption of data analytics by the insurance sector in the past, all that is rapidly changing because of the intense pressure on the industry to cut down the colossal losses caused by claims fraud.

There is a lot of regulatory importance placed on protection of personal information, with new layers of security being added regularly. This has made it extremely tough for insurance companies to access data from various sources for fraud predictions. Data analytics has proved to be a game-changer for the industry and is helping insurers manage claims fraud instances better.

Fraud Analytics Software

Insurers are incorporating insurance fraud analytics software into their business processes to detect fraudulent practices and detect such incidents early and proactively.

Fraud analytics software systems can reduce claims fraud by gathering data from various sources and collating it into meaningful and valuable information. Predictive capabilities of the software can help companies apply the process to a large area of business operations and improve fraud detection significantly. The software can be used for:

• Identifying optimal risk level
• Gaining qualitative insights from data
• Mitigate fraud risk at insurer’s end
• Eliminating fraud risk at the agent’s end
• Moving from manual to automated underwriting
• Establishing accepted limits of risks
• Automating procedures to identify risk assessment for determining various factors such as coverage, profitability and others

 

Understanding Legacy Systems

One of the biggest challenges of adopting analytics software is the need to upgrade systems to the latest versions. With technology evolving rapidly and continuously, this might entail a fairly substantial investment. Also, there are concerns around use of a third-party service or software because of privacy protection issues. Insurance companies might not have absolute control over data which can result in significant liability.

Insurance Fraud Detection Solutions:

Advanced claims fraud detection solutions are driven by technology. It works in the following ways:

Detection of Anomalies:

Multiple metrics are created to compare the behavior of various entities. The system makes use of statistical analysis to detect any anomalies that deviate from the normal behavior patterns of agents and customers.

Analysis of Claim Notes

Analytics can help in extracting information by going beyond structured data. In simple terms, it means that it can pull data about circumstances of a specific incident, the parties involved, the damage caused, treatment costs and other related data vital for claims settlement.

Investigation of Anomalies:

Agents and customers pointed out as anomalous on more than one count are singled out and detailed analysis carried out to find out the reasons for the anomalies. Business rules can be set up to prevent misuse and future frauds.

Conclusion

Insurance frauds are generally carried out in a very organized manner across the globe. In the modern world, it will be difficult to detect them without using sophisticated analysis methods. Insurers must leverage newer technologies to prevent, detect, and filter frauds. This will help improve claim adjustment expenses and improve the efficiency and performance of the industry.

Claims Fraud Network Analysis

The world today has become quite impertinent and malicious. People do not flinch committing heinous crimes and the sad part is, most of us have come to terms with it. Social media outrages and agitation are transient and thus, most criminals( no matter how big or small) get away with different kinds of transgressions. One such kind of misdeed about the business sector, is Claims Fraud, especially in the insurance industry.

Meaning:

Insurance today is considered both as a form of security and investment. It gives a sense of assurance to its client- the courage to mitigate unforeseen mayhem in life. But with the influx of fraudulent activities and felony across various industries, the insurance sector stands to be no exception. One of the ways that miscreants try to get money from insurance companies is through Insurance Claims Fraud.

Insurance Claim Frauds may be defined as the act of wilful deception or creating a hoax, to secure unlawful or unfair gain, mostly pecuniary benefits. These are false insurance claims filed with fraudulent intention towards the insurance provider. It is said that insurance fraud has existed whenever insurance policies are curated, taking different forms, to suit the economic scenario. Fraudulent claims account for a substantial portion of all claims received by insurers and cost billions of dollars annually. These, in turn, affect the lives of innocent people, both directly through accidental or intentional injury or damage, and indirectly as these crimes lead to the higher insurance premium, posing as an unjust practice towards the innocent masses. Fraud drains profit and also puts a company at a competitive disadvantage.

Types of Frauds

With the rise losses and costs, detecting and preventing fraud has been consistently ranked among the top three investment and strategic priorities for insurance executives, at the time of formulating various insurance policies. They type of such fraudulent activity can broadly be divided into two types:

• Opportunistic fraud :

It is usually perpetrated by an individual who simply has a chance to exaggerate his claim or may have window-dressed his estimate for losses and repairs to the company. It is common practice, where the claimant demands an inflated amount of money for damages, while the real value stands marginal. Such frauds are very convenient and most people believe to have gotten away with the same. The miscreant, sometimes, may have some inside information, which helps him or her to fabricate incidents convincingly and thus earn easy money.

• Professional Fraud:

Such kinds of frauds are carried out by organized groups with multiple, false identities, targeting multiple organizations or brands. They are seasoned criminals, who are aware of the loopholes of the fraud detection systems and work on the same, to curate plans to remain, just below the radar. These crime rings often place or groom outsiders, to help in the intrusion, through several company channels. It is also speculated that these criminals know the fraud detection systems and they routinely check thresholds, to determine the extent of their malpractice. They usually aim for bigger clients, with high net-worth or valuation in the market.

Techniques of deterring Claim Frauds :

With the exacerbation of unfair and fraudulent claims in the insurance industry, the insurers are required to become resourceful and inventive, to deter these criminals and discourage their motives. By using a combination of approaches-and by exploiting the advantages of analytics-based techniques, it is possible to detect these claim fraud networks, to recognize their deceptive motives and thwart their plan. Some of these techniques can be described as under:

1. Business Rules and Data-Based Searching :

It is a mechanism under which each transaction is been tested against a predefined set of algorithms or business rules and policies to address any known type of fraud based on specific patterns of activity. These systems flag any claims that look suspicious to their aggregate scores or relation to threshold values. Claims that have been flagged can be investigated and reviewed using database searching and it also provides for third party database searching, to learn the criminal history of the claimant flagged, as to whether he is on the hotlist or not. Data-Based Searching is a simplistic approach and can be seen as an auto claim management software.

2. Anomaly Detection:

Also known as outlier analysis, anomaly detection is a step in data mining that identifies various data points, events, and observations that deviate from a dataset's normal behavior and thereby detect outliers of the same. This analytical tool is very helpful for fraudulent claims management. With this, Key Performance Indicators (KPIs) associated with tasks or events are baselined and thresholds are set. When a threshold for a particular measure is exceeded, then the event is reported. This in turn helps in predicting unknown patterns or fraud. It is a simplistic claim fraud management solution, as it is easy to implement and easy to evaluate individual performance to identify problems.

3. Test Mining:

Test Mining is an analytical tool which can be used as an auto claim management software, that can be used to process large volumes of text-based information such as adjuster notes, customer service calls, claimant interview, etc- in short, unstructured text, then process into meaningful data and analyze the newly created data to gain a deeper understanding of the claim. A newly added feature of this tool is the ability to analyze the huge amount of data available within social media like Facebook, YouTube, etc, for discriminating evidence against the claimant. Thus help if effectively mining and analysis of unstructured data in meaningful ways.

4. Social Network Analysis :

A contemporary approach for the claims management system of insurance, which combines the hybrid approach of the analytical method, is Social Network Analysis (SNA). The hybrid approach includes organizational business rules, statistical models, pattern analysis, and network linkage analysis to uncover a large amount of data to show relationships via links. When one looks for fraud in link analysis, one looks for clusters and how these clusters link into other clusters. Public records such as judgments, criminal records, address change frequency, etc. can be integrated into a single model and thus ease the process of analysis.

5. Predictive Analytics for Big Data:

Predictive Analytics include the use of text analytics and sentiment analysis to look at big data for fraud detection. Claim reports span across multiple pages, leaving little room for text analytics to detect scam easily. Big data analysis helps in mining through various unstructured texts and helps proactively detect frauds and other foul practices. An important point to note here is that people who usually commit frauds alter their stories over time. This fraud detection system can spot such discrepancies, using text analytics and sentimental analysis.

It has been pertinent for various insurance companies and businesses to exploit the existing technologies at their disposal and use various claim management tools to effectively manage, detect, and report frauds. It is time, they invested in technologies to prevent claims fraud, before it reaches epidemic proportions.

Innovations in Demand Management Solutions for Insurance

If you are in the claims or claims management business, chances are that you have a more than casual acquaintance with time limit demands (TLDs). Insurance providers receive thousands of documents every day, including demand letters from claimants’ attorneys, and time is not the insurer’s friend when it comes to TLDs. Settlement communications, while a powerful litigation tool for attorneys of an insured, are notoriously hard to handle for the insurer and can lead to recovery in excess of the policy limit in certain cases.

Any action leading to strengthening of the claims validation and vetting process stands an insurer in good stead. In this article, we examine the challenges, the requirements of a typical claims department and demand management solutions for insurance companies in the context of TLDs.

Challenges

Not only is the sheer volume of attorney demand letters a challenge for insurance providers, the complexity of the letters poses an additional dimension of difficulty. The demands can be buried in thickets of complex legal verbiage, leading to ambiguity on key information. In addition, the manual review and tracking of milestones for numerous demands is prone to greater errors.

A TLD that is not identified and managed in time puts an insurer at risk for bad faith exposure and potential litigation, possibly with higher settlement costs. Investing in a demand management solution that can significantly reduce the margin of error in identifying, tracking and managing offers a crucial extra level of protection for insurers.

Serving the Needs of the Claims Team

Adjustors handle multiple claims every day, each associated with multiple documents in turn. Responsible for identifying demand letters and evaluation of the related documents, their most critical responsibility is to understand the specifics and respond to the letters in the stipulated time. Most adjustors manually identify, assess and track demand letters - a process that is both error-ridden and time consuming.

A demand management solution that has the capability to identify demand letters from other correspondence, cull the key information from them and track them through their lifecycle is the need of the hour for adjustors. The volume of TLDs also creates the need for a concise dashboard that can reflect the stage of each demand, has tracking and notification capabilities and has built-in assistance features can be a powerful aid for adjustors. Coupled with modern tools for rapidly processing thousands of documents, it would enable adjustors to gain early awareness of demand letters and increase efficiencies in identifying high-risk demands. It’d also help reduce human error and eliminate losses due to misinterpretation of attorney demand letter response dates.

Claims managers who lead a team of adjustors perform the critical function of ensuring that the TLDs received by the team are processed accurately and on time. A demand management solution that can help claims managers track the status of TLDs under process, raise flags for unanswered demand letters, notify imminent milestones and help configure the team as per need can support managers in increasing the effectivity of the team.

The effectiveness of the claims division lies with senior management who bear the onus for reducing losses due to missed demands. While they need an overall view of the claims, their specific responsibilities require support for their intervention at critical stages, handling exceptions and the ability to reassign personnel to create the most effective teams. They also require their demand management solution to enable them to help track the total demands and exposure values as well as track negotiation offers.

Cogitate Demand Management Solutions for Insurance Carriers

Cogitate Demand Management, a part of the Cogitate Intelligent Claims suite for insurance companies, is a powerful tool for attorney demand letter identification and management. One of its kind, it offers protection against bad faith exposures, loss in claims and mitigates the risk of a missed demand letter that may lead to significant settlement costs. Cogitate Demand Management is capable of parsing complex legal verbiage, identifying demand letters and tracking key dates and offers made in negotiations. A special feature is the use of OCR, text mining and ML to automate identification and management of demand letters. The solution offers complete life cycle management with configurable tracking and notifications, flexible team management features and easy integration with many existing Document Repository Systems and Claims Management Systems. Talk to us today to learn more about how demand management solutions our for insurance carriers and MGAs can help them achieve greater control over attorney demand claims exposure and surpass the needs of your claims division.

Innovations in Demand Management Solutions for Insuranc

If you are in the claims or claims management business, chances are that you have a more than casual acquaintance with time limit demands (TLDs). Insurance providers receive thousands of documents every day, including demand letters from claimants’ attorneys, and time is not the insurer’s friend when it comes to TLDs. Settlement communications, while a powerful litigation tool for attorneys of an insured, are notoriously hard to handle for the insurer and can lead to recovery in excess of the policy limit in certain cases.

Any action leading to strengthening of the claims validation and vetting process stands an insurer in good stead. In this article, we examine the challenges, the requirements of a typical claims department and demand management solutions for insurance companies in the context of TLDs.

Challenges

Not only is the sheer volume of attorney demand letters a challenge for insurance providers, the complexity of the letters poses an additional dimension of difficulty. The demands can be buried in thickets of complex legal verbiage, leading to ambiguity on key information. In addition, the manual review and tracking of milestones for numerous demands is prone to greater errors.

A TLD that is not identified and managed in time puts an insurer at risk for bad faith exposure and potential litigation, possibly with higher settlement costs. Investing in a demand management solution that can significantly reduce the margin of error in identifying, tracking and managing offers a crucial extra level of protection for insurers.

Serving the Needs of the Claims Team

Adjustors handle multiple claims every day, each associated with multiple documents in turn. Responsible for identifying demand letters and evaluation of the related documents, their most critical responsibility is to understand the specifics and respond to the letters in the stipulated time. Most adjustors manually identify, assess and track demand letters — a process that is both error-ridden and time consuming.

A demand management solution that has the capability to identify demand letters from other correspondence, cull the key information from them and track them through their lifecycle is the need of the hour for adjustors. The volume of TLDs also creates the need for a concise dashboard that can reflect the stage of each demand, has tracking and notification capabilities and has built-in assistance features can be a powerful aid for adjustors. Coupled with modern tools for rapidly processing thousands of documents, it would enable adjustors to gain early awareness of demand letters and increase efficiencies in identifying high-risk demands. It’d also help reduce human error and eliminate losses due to misinterpretation of attorney demand letter response dates.

Claims managers who lead a team of adjustors perform the critical function of ensuring that the TLDs received by the team are processed accurately and on time. A demand management solution that can help claims managers track the status of TLDs under process, raise flags for unanswered demand letters, notify imminent milestones and help configure the team as per need can support managers in increasing the effectively of the team.

The effectiveness of the claims division lies with senior management who bear the onus for reducing losses due to missed demands. While they need an overall view of the claims, their specific responsibilities require support for their intervention at critical stages, handling exceptions and the ability to reassign personnel to create the most effective teams. They also require their demand management solution to enable them to help track the total demands and exposure values as well as track negotiation offers.

Cogitate Demand Management Solutions for Insurance Carriers

Cogitate Demand Management, a part of the Cogitate Intelligent Claims suite of demand management solutions for insurance companies, is a powerful tool for attorney demand letter awareness and management. One of its kind, it offers protection against bad faith exposures, loss in claims and mitigates the risk of a missed demand letter that may lead to significant settlement costs. Cogitate Demand Management is capable of parsing complex legal verbiage, identifying demand letters and tracking key dates and offers made in negotiations. A special feature is the use of OCR, text mining and ML to automate identification and management of demand letters. The solution offers complete life cycle management with configurable tracking and notifications, flexible team management features and easy integration with many existing Document Repository Systems and Claims Management Systems. Talk to us today to learn more about how our demand management solutions for insurance carriers and MGAs can help them achieve greater control over attorney demand claims exposure and surpass the needs of your claims division.

The Nexus of Forces and Insurance Fraud Analytics

Gartner Inc coined the term Nexus of Forces to describe the concept of how the collective power of four forces - social media, mobility, cloud computing and information patterns –is rapidly shifting the nature of digital business and creating new business opportunities. With great transformative impact individually, the intersection shows extraordinary potential for transmuting industries and pushing fresh opportunities for information innovation.

A key transition element for many industries, the nexus empowers insurance providers to alter and adapt business processes in real time through this blend of technology, data and analytics. Gartner also makes the case for strategic use of the nexus instead of piecemeal, incremental investment in the individual constituents. Many insurance providers have invested heavily on data insights, but the true potential of these forces lies in the future-focused insurerem bracing these advancements fully for a competitive edge.

Among the many advancements made possible through this confluence, one of the foremost is strengthening insurance fraud management systems by deploying innovative fraud technology and enhanced modeling. As insurance fraud grows more sophisticated, the nexus allows insurance providers to deploy more aggressive and proactive insurance fraud management systems. Innovative strategies that leverage a combination of data, new technologies and capabilities to support insurance fraud analytics and prediction hold rich potential for the innovative insurance provider.

Some key information innovations for reducing underwriting and claims fraud include predictive modeling and anomaly detection through enhanced analytical and prognostic capabilities. Business rules-based detection and classification supported by evidence-based data assist faster identification of fraud. Similarly, pattern detection and identification assist identification of new specious behavior and improve modelling.

Scoring algorithms that use historical and other claims data to generate the fraud probability score of a claim and predict probability of fraud are such advancement. Solutions based on complex machine learning models and neural networks are trained to identify and predict fraud using historical and other claims data, as well as learn new patterns of fraud and protect against future risks.

Early identification of fraud networks through social network and trend analysis helps in discovery of fraudulent parties involved in suspected fraud and in the creation of an association-based network graph based on location, address and individuals. Once a fraud collusion network is identified, multiple filters can be applied on the network graph to gather more data which may not be available via traditional BI practices and help further hone claims fraud analytics capabilities.

Cogitate Claims Fraud Network Analysis (CFNA) allows faster identification of fraud through the use of multiple scoring tools, neural networks and fraud collusion networks. CFNA uses artificial intelligence, machine learning, advanced insurance fraud analytics and social network analysis for claims fraud analytics and protects insurers against spurious claims.

Claims reflect in CFNA within 24 hours of the First Notice of Loss (FNOL) and with automated backend processing, fraud probability scores and network graphs are generated right at the FNOL stage. Segregating fraudulent and non-fraudulent claims to assist faster settlement of claims ensures enhanced satisfaction for the customer and significant economies for the insurer. Early referral of fraudulent claims to the Special Investigation Unit (SIU) and automated assignment to adjustors and SIU helps in faster claims settlement and brings further savings in operational costs for insurance providers.

To learn about the many ways Cogitate can help insurance carriers reduce loss ratio and bring in significant savings, contact us today

The Changing Face of Insurance Distribution Management

Consumers are increasingly looking for digital innovations, especially in an age where direct contact between parties is discouraged, as they seek insurance solutions that meet their needs, on their terms and at speed. The challenge is that not all distribution channels rise to these consumer expectations and behavior, forcing the need for establishing multi-channel insurance distribution strategies.

 

The transition into a greater digitalization of insurance distribution management is highlighted in a recent survey of more than 400 senior executives responsible for agency and insurance distribution management. From discovery of information, through to advice and purchase, the survey found that every stage of the sales process is experiencing a radical shift as insurers move to digital omni-channel distribution.

 

Challenges

The proliferation of digital technology, the power of data and the social phenomenon are helping insurers connect with customers during important life events via the direct channel. Yet, as the IIABA 2017 Market Share Report shows, agents and (represented by the National and Regional categories) brokers not just endure, but remain dominant. They play a critical role in product selection and explaining products and processes often perceived as complex by customers. Added to this mix are internet-based selling through an insurer’s own website as well as aggregators, and multiple other channels.

 

 

Providers lose the risk of loss of business if a consumer is daunted by a complex, slow or siloed buying experience or application process. Today’s consumers demand personalized services designed around their preferences rather than a one-size-fits-all offering designed by an organization. They want simplicity, speed, tailored options and value-added services from their insurer.

 

A seamless omni-channel buying experience that reaches the customer at the right moment and in the right context is the need of the hour for insurance distribution management.

 

Trends

Increasingly, forces beyond the control of insurance providers are challenging their traditional insurance solutions and models. As a series of technological and other disruptions shape the nature of their business, innovation and customer centricity have become imperatives for insurance distribution strategies.

 

In all aspects of their life, consumers have voiced a definitive demand for “living services” that requires a re-appraisal of the relationship between consumers and service providers.  As everything becomes digitalized and data the queen of all she surveys, a larger emphasis is placed upon the Internet of Things as a medium of interaction between customer and carrier as insurance transforms to real-time protection from mere indemnification.

 

The second pillar of living services is based on consumer experiences. In recognition of the need for customer centricity, insurers are building capabilities as they move from a product-focused sales philosophy to one driven by their customer’s needs. Indeed, there is no one, definitive customer anymore as organizations develop customer segmentation strategies and functions to enable tailored, connected and intelligent offerings.

 

Cogitate Distribution Management for Insurance is a suite of insurance solutions for end-to-end digitalization of distribution and enhancing user experience. It improves efficiencies and reduces costs by allowing insurance companies to add new agents online and move into new territories quickly. It is a scalable, configurable platform which combines solutions for growing an agent network, agent self-service and monitoring the sales performance of corporate and agency networks. Talk to us today to see how Cogitate can help modernize your distribution strategy.