3 crucial steps for insurers’ SIU departments success
6 mins read

3 crucial steps for insurers’ SIU departments success


SIU units must have all the necessary tools at their disposal to make timely and accurate decisions about paying claims

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With around 10% of all insurance claims estimated to be fraudulent, the role of Special Investigations Units (SIUs) at insurance companies has never been more critical – or demanding – in helping uncover fraud. No wonder that, according to a recent survey, almost all insurers said they now have a formal SIU to help them uncover suspicious activity and complete complex fraud investigations, compared to only 87% just over a decade ago.  

In order to do their jobs well, SIU units must have all the necessary tools and capabilities at their disposal to make timely and accurate assessments about whether claims should be paid out. Here, we explore three crucial steps for setting SIU departments up for success.

Step 1: Enable access to the most up-to-date data

Thorough investigations rely on piecing together multiple pieces of information but given that there are often time-limits on making claims decisions, SIU investigators are under pressure to do so fast. Without up-to-date, accurate and relevant data, they cannot verify personal details, check claims information provided, or spot unusual patterns or strange anomalies in claims documents or claimant behavior. This could create delays in confirming that claims are genuine (or not), or worse, lead to the wrong decisions being made about payments. 

The intelligence investigators need is often hidden in disparate databases, including public records systems such as social security and death records, and even sanctions lists and media reports. So, tools that can integrate with all the necessary data sources in real time, speeding up searches, drawing out the latest appropriate information and performing advanced data analytics to make it meaningful, are vital and needed to succeed. This will give investigators the comprehensive insights they need to make informed assessments in an efficient manner, so that cases can be resolved more quickly and the chances of detecting and preventing fraud are dramatically increased. 

 

Female runner along empty road during mountain golden hourFemale runner along empty road during mountain golden hour

 

Step 2: Facilitate cross-functional collaboration

SIU investigators won’t be as effective as they could be if they are operating in siloes. Working closely with customer onboarding and claims teams is to be encouraged so that they can gain a clearer picture of a customer or a claim, put their investigations data into context and see the bigger perspective in terms of trends. Often, experienced customer-facing teams get a gut feeling when something doesn’t look right, or they may have seen a scam before. Or, being closer to the customer, they may be in a better position than investigators to say whether suspicions sound justified. 

What’s needed, then, are clear communications channels, so that investigators can tap their customer-facing colleagues for their views on a particular case, and customer onboarding and claims teams can raise any concerns directly with the SIU. Even better if they are in regular contact as a matter of course, for example via intelligence sharing briefings or joint training sessions, and if they have access to a shared databases where they can update each other on key fraud indicators. This kind of cross-functional collaboration will make investigations more robust and well-organized: a recipe for success.

Step 3: Develop a strong culture of continuous learning

Criminals are constantly finding new ways to perpetrate fraud, and increasingly they are using digital means to carry out ever more sophisticated and hard-to-spot scams. Investigators must keep up to date with the emerging techniques fraudsters are using and learn how to use smart technologies such as artificial intelligence (AI) or biometrics themselves in response to detect fraudulent activities. 

It is essential for success that SIUs receive regular, ongoing education and training about the latest threats and how to combat them, via seminars and workshops, as well as participation in industry conferences and webinars, together with access to the latest research and publications. By establishing a learning culture and framework as a best practice, the skills and knowledge of SIU team members will be enhanced, and the SIU as a whole will become more adaptive and resilient. 

Although, as pointed out in a new Thomson Reuters e-book, having an SIU is not a legal requirement everywhere, it’s clear that insurers are recognizing the value of having a specialist team dedicated to fraud detection and prevention. Having put those teams in place, SIUs must be suitably equipped to undertake the major task at hand: with current, complete data readily available, the insight and support of customer-facing colleagues, and a program of continuous learning. In this way SIUs will be empowered to investigate effectively and efficiently, make better decisions, close cases faster, and be ready to keep tackling fraud as it continues to evolve at pace in the future. 

Learn more about how fraud is impacting the insurance industry and how insurers can fight back. 

Shielding the future of the insurance industry e-bookShielding the future of the insurance industry e-book

 


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