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Balancing Objectives at First Notice of Loss

Jason Ferrall
Blog Post06/29/2018
Business Fraud and Identity Management
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When it comes to insurance claims, customers seek fair, thorough and quick resolutions. Carriers delivering this standard of service show higher levels of customer retention, while reducing claim costs and processing time. Undoubtedly, the faster a claim is resolved, the better for everyone involved. But how can you consistently make that happen?

Finding balance between strong risk mitigation, fraud protection and exceptional customer service is essential at first notice of loss (FNOL). The first challenge is volume. How do you quickly gather all the data needed for each claim? And do you have reliable systems and processes in place to turn that data into actionable and valuable insights?

If answering these questions feels like a mammoth task, it’s time to review your processes.

Determine if it’s time to deploy new strategies

In an insurance utopia of fraud mitigation, savvy carriers act fast at FNOL:

  1. Know FNOL analytics are your friend. Whether built in-house or by a third party, having a process that can attribute a FNOL score to each claim is essential in today’s competitive landscape.
    • A combination of rules-based systems (taking advantage of known issues or schemes) and artificial intelligence (AI) and machine learning is key to a multifaceted platform.
  2. Utilize data, data and more data to drive better decisions. Examples of clear, actionable data include:
    • Policy data  – Application, date, exemptions, and other information from new business and renewal underwriting reviews
    • Claim event data – Date, time, others
    • Loss history
    • Third-party public record data – Since many claims will look the same, the addition of public records adds granularity to distinguish which claims need more attention
    • Derived meta data – Detect anomalies in reported claim information, for example, a claim happened on a Friday but wasn’t reported until the following Monday
  3. Triage — Build and use scores to triage claims and identify potential fraud; most claims will pass through the process with few, if any, issues.
    • For those that pass through, you can streamline for fast pay/closure. This benefits carriers by freeing reserves, satisfying customers and closing claims.
    • For those needing more review, use data to help an adjuster clarify any questions and move the claim forward with the insured.
    • For the small percentage of claims that are flagged for fraud, get them to SIU immediately to start an investigation. You can identify potential fraud faster and SIU has a starting point based on the scoring.

In today’s SIU environment, more and more claims end up in investigations which taxes SIU resources.  Scoring specifically for fraud — after the FNOL score — can help deploy SIU assets on those potentially fraudulent files triaged by scoring.

Adding public record data is a key differentiator in risk mitigation at claims. Insights gleaned from each score can help carriers more swiftly identify potentially fraudulent claims at first notice of loss. That coupled with quickly moving honest claims through satisfies the aforementioned trifecta of balanced objectives that benefit all involved.

If you’d like to learn more about bringing balance to your process or how TransUnion solutions can bring value to your organization, contact us below.

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