A.I.M. Harnesses the Power of Analytics and Predictive Modeling to STOP Fraud Before it Starts
SAN DIEGO, March 11, 2016—ICW Group Insurance Companies, a group of property and casualty carriers, announced today that it has developed a sophisticated proprietary analytic process to detect, deter and defeat workers’ compensation insurance fraud. This first-of-its-kind Analysis Investigation Module (A.I.M.) begins working to identify fraud immediately upon a claim submission, and predicts harmful trends that empower the company’s special investigation unit (SIU) team to prevent deceit from impacting its customers’ businesses.
“No other insurance company has an intuitive technology platform that moves faster than the speed of fraud,” said Mike Bender, director of ICW Group’s SIU. “With predictive analytics, big data implementation and investigative experience, A.I.M. red-flags questionable behavior before it spreads like a virus.”
Healthcare related workers’ compensation fraud costs the U.S. between $75 billion and $250 billion every year. Organized criminal enterprises use very sophisticated and complex schemes to perpetrate work comp fraud, causing catastrophic losses for businesses and their employees. “No one tool met our standards, in terms of protecting our customers—so we built our own,” said Danny Engell, vice president of enterprise strategic planning and analytics at ICW Group.
Created by a consortium of innovative team members from ICW Group’s actuarial, enterprise strategic planning and analytics, IT and claims departments, A.I.M. synthesizes more than 20 unique data sources, including proprietary claims information, national and state records, and industry archives. “It uses this comprehensive insight as an astute investigative lens to examine every single claim submission,” said Ying Huang, actuary at ICW Group –and one of A.I.M.’s chief architects. “Other antifraud tools only address part of the problem, and do not also specifically address our customers’ needs of reducing expenses, keeping employees healthy and getting injured workers back to work healthy,” added Bender.
Organized criminal enterprises create teams of dishonest providers to bilk the system and abuse injured workers. “Typically, these fraud rings are able to rake in millions of dollars for 5-10 years before they land on an insurance carrier’s radar—all the while causing serious harm to injured workers with excess or unnecessary medical procedures,” said Amanda Granger, vice president of work comp claims at ICW Group. “A.I.M. provides our customers added layers of defense and peace-of-mind that come from fewer fraudulent claims, improved quality of medical care for their injured workers and decreased overall work comp costs.”
The platform is already demonstrating impressive results. During beta, it:
- Increased arrests, indictments and restitution on fraudulent claims
- Decreased claims costs from fraudulent, questionable and suspicious claims
- Identified and stopped organized criminal enterprises from attacking ICW Group and its customers
The “A.I.M. platform will continue to evolve over time,” explained Engell. “It’s fluid and continually updated with new industry trends, organized criminal behavior, laws and new analytic capabilities to identify fraud.”
About ICW Group
Based in San Diego, ICW Group Insurance Companies is the largest privately held group of insurance companies domiciled in California. Quoting more than $3 billion annually, ICW Group represents a group of Property, Auto and Workers’ Compensation insurance carriers, including Insurance Company of the West and Explorer Insurance Company. ICW Group is recognized nationally as an industry leader in helping policyholders achieve fewer and less costly claims, and is committed to meeting the needs of its policyholders and elevating the trusted agents and brokers who advise them. More information is available at www.icwgroup.com, www.twitter.com/ICWGroup and www.facebook.com/ICWGroup.