Future of Insurance Fraud Investigations – Trends and Opportunities

On a warm sunny afternoon in May, with the help of Instech, the great and the good of the insurance investigations, we gathered in the highest private dining room in London at the fabulous Duck and Waffle to discuss the future of insurance fraud investigations. The view was fantastic, the food delicious, but best of all the conversation was compelling.

State of Economy and Insurance Fraud

The background to the discussion was the state of the economy. As we all know, financial pressures are one side of the fraud triangle and we are hearing words like stagflation, mortgage timebomb, and squeezed middle. There is no doubt that stubbornly high levels of inflation reduce purchasing power, and this shows no sign of slowing down. So, the consensus was an expectation of increased volumes of opportunistic fraud to go alongside the insidious and ever-present threat of sophisticated organised fraud.

Insurers have been investing heavily in improving fraud detection technology and techniques. The combination of improved detection and increased levels of both opportunistic and organised fraud mean that investigations teams will have many challenges ahead.

When I was a claims handler (yes, that was a long time ago!), nothing frustrated me more than suspecting fraud and not being able to prove it, and then having to pay out a claim I found suspicious. Today’s investigations teams are facing this challenge with increasing levels of referrals that will constrain limited resources. For all the investment in improved technology to detect fraud, it is the investigator who actually proves the fraud and makes the saving. All too often, tooling to help the investigator to do their job better is the last in the queue.

How to Reduce Manual Processes

The conversation varied widely, including covering the potential impact of Large Language Models. Interestingly, the consensus seemed to be, whilst these may be interesting in the future, there are other opportunities for improvement of a more fundamental nature to reduce manual processes such as:

• Integration: Too much re-keying of information, data sat in silos and not connected

• Connectivity: sounds like the same thing, but having the appropriate third-party data or OSINT at your fingertips can cut down hours of investigative resource

• Workflow: assigning the right resource, process, skillset to a case

• Management Information: dashboards for both management and individual experts to have a transparent view of workloads at a global and individual level

• Reports: the ability to cut down the hours of compiling a report manually, printing and collating a file for prosecution, to minutes

There was also consensus on the difficulty in making the internal business case for investment in the tooling to achieve the above, beyond a pure person hours saving. These are the conversations we want to have!

So when the food was eaten, we adjourned to the outdoor terrace at Sushi Samba, under the very appropriate orange tree, to continue the conversation.