Insurance Industry Solution Presentation

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    11-Nov-2014
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    Technology

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Costs for claims processing and resolution are on the rise, as providers increasingly struggle to combat fraud. Join Attensity’s James Purchase, Senior Director of Industry Solutions, to learn how Attensity’s Insurance Industry Solution helps insurance providers find cost-effective ways to identify fraudulent claims and customer pain points, improve competitive rankings, win new business and retain loyal customers.

Transcript of Insurance Industry Solution Presentation

  • 1. Attensity Webinar SeriesCustomer Experience Management in the Insurance P&C IndustryWith James Purchase, Senior Director of Industry Solutions, Attensity#AttensityWebinar
  • 2. Agenda Introduction to Attensity Insurance P&C - High Loss Ratio Challenge Insurance P&C - Benefits of Unstructured Claims Analytics Use Cases: Detection of Fraudulent Claims Accurate Identification of Subrogation Enhanced Claims Analysis Survey Verbatim Analysis Member/Non-Member Review Analysis External vs. Internal Review Analysis Social Media Buzz & Sentiment Insurance P&C Solution Deliverables Summary & Conclusions Q&A
  • 3. About AttensityHelp the worlds leading brands leveragecustomer conversations as a business asset.No matter where they take place:social media blogs surveys call center notes review sites emails more 10+ years of experience in Text Analytics/CEM 7 patents in natural language processing 500+ installations worldwide Worlds largest NLP development group
  • 4. We Work with the Worlds Leading Brands Customer Service BI Text SCRM Analytics VOC
  • 5. Attensity Social Analytics and Engagement SuiteReal-time annotated social ATTENSITY COMMAND CENTERmedia data feed: 75+ millionsocial and online sources ATTENSITY PIPELINEPlus internal sources: emails,surveys, CRM notes, etc Enriches and tags the data Extracts people, ATTENSITY ANALYZE ATTENSITY RESPOND Deep sentiment, root cause analysis and trending Social customer engagement solution places, things, events
  • 6. Insurance Industry Solution Built on Attensity Analyze: First Text Analytics Solution Designed for Business Users One of a series of industry solutions Includes out of the box: Industry specific Dashboards, Reports, Categories, Topics Patented semantic analysis for extracting detailed insights from text Sentiment and root cause analysis Trend analysis Continuously updated social media feed & market intelligence Point and click wizard for creating custom reports & dashboards
  • 7. P&C Industry - High Loss Ratio Challenge Most property and casualty (P&C) insurers ended 2011 with dismal financial results, with many insurers experiencing year-over-year deterioration. Carriers are looking for ways to correct the High Loss Ratio!
  • 8. Insurance P&C - Benefits of Unstructured Claims Analytics 80% of all claims data is unstructured, which makes spreadsheet analysis of standard data ineffective. Claims analysis of unstructured data can drive major financial improvements in areas such as: Fraud Subrogation Provider Network Management Source:
  • 9. Use Case: Improving Detection of Fraudulent Claims UK National Fraud Authority estimates 2 billion in fraud annually. 10% of all US P&C claims are fraudulent representing over $40 Billion of cost to the industry Industry best practice finds fraud in 1 to 3% of claims The Claim Adjuster workforce is aging: 70% is over 45 years old knowledge and experience is leaving the industry Average claim settlement times are too long, driving loss and adjustment expense higher
  • 10. Use Case: Improving Detection of Fraudulent Claims Claims Administration Straight through processing Dictionaries Appropriate Claim Examiner Workers Compensation General Liability Auto SIU Claims Database All data is Claims are Text Sources All claims are fused analyzed assigned to 1 Intelligent Workflow Social Media together of 4 tiers Email Supervisor Other
  • 11. Use Case: Improving Detection of Fraudulent ClaimsFused claim records:Claims enter the funnel using filteringoptions to identify claims to be processed Tiered Claims claims in this tier show no suspicion and Tier 1 should be fast tracked No Suspicion Tier 1 claims in this tier show minimal signs of Tier 2 suspicion and may require analysis Tier 2 Score claims in this tier show stronger signs of Tier 3 Tier 3 suspicion and should be analyzed Tier 4 High Suspicion claims in this tier are highly suspicious and Tier 4 should be referred to SIU Actionable Claims
  • 12. Use Case: Improving Detection of Fraudulent Claims Reduced costs Addressing fraudulent claims earlier in the process reduces the overall claims cost. Training Text analysis uncovers inconsistent use of red flags across claim examiners and identifies training opportunities. Improved regulatory Analysis of text identifies suspicious claims not compliance reported to state agencies. Knowledge capture Allows for the capture of fraud intelligence and the consistent application across claims. Provides a hedge against loss of knowledge .
  • 13. Use Case: Improving Detection of Fraudulent Claims Provides a cumulative view of claims. In this example over Drilling into this claim which is 50% of claims are a Tier 3 we see the presence of characterized as : 4 indicators! Neck, Back, Shoulder, Arm & Knee injuries! Claims Details provides additional information such as Given that this is a Tier 3 claim Gender, Age, Health Profile we can update the status as Sent to SIU Many Red Flag Indicators are publically known but many are specific to a product/carrier and others continue to emerge! The presence of multiple Red Flag Indicators can lead toshows a breakout of the This Fraud Tiers. The more highest occurring flag indicators present theindicators. more suspicious the claim!
  • 14. Use Case: Accurate Identification of Subrogation Subrogation is the process whereby one insurance company, whose customer was not at fault, recoups paid claims from the company of the individual res