Ex-military analytics whiz focusing on fraud

Ex-military analytics whiz focusing on fraud | Insurance Business

Ex-military analytics whiz focusing on fraud
The Insurance Council of New Zealand (ICNZ) has sharpened its focus on fraud in the form of new recruit Dave Ashton, who has recently been appointed manager of the Insurance Claims Register.

Ashton comes from a background in the RAF using advanced computer software to analyse military intelligence in the Middle East and Afghanistan.

Now he is turning that expertise into helping ICNZ’s member companies prevent the 10% of dodgy claimants who reportedly cost honest policyholders more than $350 million per year.

The Register was set up in 1999 by six member companies, Vero, AA Insurance, IAG, Tower Insurance, Lumley and FMG, to share customers’ claims histories in order to detect purposeful non-disclosure or double dipping at claim time.

But Ashton says it’s only now that a dedicated coordinating role has been created that the 6.1 million records can be properly analysed and used more effectively – once they have first been loaded that is.

He told Insurance Business one of his roles was to do a strategic oversight of the data: “I will drill down into the collective data set of over 6 million records and hopefully provide more value to the members by looking for patterns and trends.

“For instance, I can look at geo-spatial information about where hotspots of claims are made.

“That’s particularly interesting from a crime perspective if you’re looking for patterns of histories where family members have colluded to make fraudulent claims you can start seeing trends and patterns using timelines, or hot spotting in certain areas.

“Another example is looking at demographics comparisons, so while we don’t hold a lot of personal information we have dates of birth so we can look at trends or patterns in age groups.”

The software can also identify anomalies where a person or company has made more claims than the normal expectation – by red flagging anything unusual companies can decide what might warrant further investigation.

Other benefits include improving business flow with real time monitoring being introduced in the next 12 months.

“We’re looking at real time monitoring as opposed to the manual search and return so when someone puts a claim in to the call centre and they start to fill the details out, the system can be cross referencing the ICR at the same time, and this will help combat double dipping.

“It can also help the client, particularly new business as it automates the process so instead of referring to the underwriter and waiting for assessment some of that process can be shortened by having the ability to make assessment quickly.”

An online form is also just about to be launched where people can anonymously report potential fraudulent behaviour as opposed to making a telephone call, which can sometimes act as a barrier, he said.

Ashton held a workshop in Auckland last week aimed at recruiting the other 15 ICNZ members who so far haven’t signed up to the ICR.

While he couldn’t go into specifics he said the five original members had found the cost of membership on the ICR was completely outweighed by the value they gain when assessing risk for setting premiums based on valid claims histories. It also served as a useful deterrent to potential fraudsters, he said.

Clients are told upfront their claims information will be lodged on the ICR and while they have the right to object to this happening, insurers also have the right not to insure customers who do object.

“For the industry it makes sense that the more information we have and the more we share the better understanding we can have of the true problem of fraud,” said Ashton.

“The other thing is to protect those businesses, because the ICR can be seen as a deterrent the other companies who are not members of the ICR could find themselves in the position where people who are looking to mislead or hide their claims history may gravitate to the other companies that are not active members of the ICR.”

Ashton said ICNZ was in discussions with eight companies who were interested in joining the ICR.