Insurance companies play a very important role in modern society by providing invaluable safety nets and protections to people from all walks of life. From health insurance to car insurance, to life insurance, and many more, this industry is something that many people look to as an investment in the future and an avenue that can be turned to during a crisis. With thousands of claims coming at each insurer every year, and the number only expected to increase over time, insurers need advanced analytical software, like SAS insurance analytics software, to oversee and manage key areas within insurance – fraud detection, for example.
Fraud detection has become such a critical issue to insurers in recent years given the vast number of discrepancies that occur annually, which have led to losses of more than a $100 million in some instances. Many of these discrepancies occur and/or go unnoticed largely due to the fact that insurers rely on inconsistent and disparate operational systems that host vital data regarding claims and billing in different, decentralised locations. This forces businesses to rely on “gut-based” business decisions and insights, as opposed to data-driven ones.
Fortunately, by utilising opportunities like Selerity’s Installation and Administration services, insurers can now create and maintain a SAS environment that significantly reduces costs, data preparation time, while making fact-based decision-making and access to insights much simpler. The SAS insurance analytics software enables users to detect and mitigate fraud in three key ways, which is elaborated upon in the following sections – let’s begin with how SAS software streamlines overall processes.
SAS insurance analytics software supports fraud detection by streamlining processes
Given that the SAS platform would transform an insurer’s operations from one that uses disparate systems into one that utilises a single centralised platform, end-users would benefit from the availability of comprehensive case management tools that can facilitate more efficient investigations. All data is captured in a central location and can be accessed/amended without corrupting the integrity of the data with duplicate data entry.
Additionally, the fraud framework within SAS gives users a comprehensive view by processing data via advanced analytics models and complex rules engines. The result of this is that insurers can now detect previously unknown fraud schemes through customized anomaly detection methods while identifying fraudulent claim rings and clusters that result in greater losses.
Identify fraud faster via SAS insurance analytics software
SAS software utilises a four-pronged approach when it comes to identifying fraud. It does this by merging business rules, anomaly detection methods, predictive analytics, and social network analysis to identify hidden relationships and subtle behavioral patterns within their client data.
Additionally, the software employs real-time scoring, which is designed to identify and catch fraud, immediately. Through this technology, insurers have the capacity to iden
tify repeat offenders and uncover insider or collusive fraud by merging staff-related data and audit records – giving them a complete view of their fraud vulnerability/potential via a single platform.
Prioritise your fraud detection investigations
While there are hundreds, if not thousands, of claims coming an insurers way each month, there are also significant numbers of potentially fraudulent claims as well. SAS insurance analytics software comes powered with a fraud scoring engine that allows insurers to improve overall investigator efficiency, while determining which cases to prioritise, based on ROI and higher value networks. This means that insurers would be able to identify when and where to spend their resources while focusing on cases that have the greatest impact on their cost-savings.
The story of Bupa
The biggest priority for our team here at Selerity is ensuring we deliver the highest possible value to our clients on any given day – this includes both quality of service and savings facilitated. In the case of Bupa Australia, this is exactly what we did.
In the way that Selerity strives to deliver its customers the best possible results, Bupa embodies the exact same commitment, which is what prompted them to approach us. With the goal of reducing the price of premiums for their customers, Bupa sought to leverage their SAS software to control their claims line. It’s important to highlight that prior to approaching us, Bupa already had a SAS environment in place.
However, one thing we have come to learn is that there is a significant difference between having access to data and analytics versus utilising these insights effectively. A business can have access to all the tools in the world that gives them all the data, however, if this is not leveraged and adjusted in a manner that reflects your business’ operational needs, it would be like trying to walk through a stone wall. This is where our Managing Director, Michael Dixon, and the Selerity team’s expertise came into play.
Michael spent over 18-months consulting full-time with the Bupa team – setting up the required SAS architecture and building a suitable data warehouse to hold Bupa’s claims-related information. In addition to providing value at the inception of the project, Michael also played a significant role as an adviser and process expert, which enabled many SAS business users, from non-IT related fields, to control and leverage the analytics platform.
The result of our contribution? By combining the two valuable aspects of integrating a SAS environment that provided the insights needed by Bupa staff, while also strengthening and enabling operational teams with knowledge of how to use the SAS software, Bupa’s ROI is estimated to be $150 million in savings – keep in mind that this was considered a conservative estimate. That number is not a Selerity estimate – it comes directly from Bupa’s Information Delivery Manager at the time.
Selerity’s specialty is not just in setting up a SAS environment within businesses, rather, it’s all about empowering personnel and organisations with the ability to leverage these analytical insights and make better businesses decisions that save time and money.