SIU Today Fall 2021 - 6

HOW AI HELPS INSURERS FIGHT FRAUD
By Gary Saarenvirta
How can insurance carriers strike the right balance of using AI
technology, combining it with their teams' work, and integrating
it into the future of fighting insurance fraud?
The Coalition Against Insurance Fraud has pegged the
annual cost of fraudulent claims in the United States alone
as $80 billion. (1)
The cost of fraud - both the payment of the bogus claim and
the ongoing costs of combatting fraud - gets passed on to
policyholders, which drives premiums higher. This forces
businesses to cover the increases by raising prices for goods
and services, which then eventually ends up being absorbed
by consumers.
Insurance fraud investigators have a tough job in the best of
conditions. As the Coalition's Executive Director Matthew
Smith recently noted,
" The primary goal of the Coalition Against Insurance Fraud
is to inform and protect American consumers about the costs
6 SIU TODAY | FALL 2021
and damage insurance fraud inflicts on everyone. The best
way for the Coalition to achieve that goal is to partner with
not only our nation's major consumer advocates, insurers, and
government leaders, but also with the anti-fraud technology
leaders. Together, their efforts will reshape how insurance fraud is
investigated for decades to come. When done properly, their work
and innovations will both better protect consumers and empower
front-line fraud fighters with the tools they need for the future. "
" Simply stated, insurance fraud investigators
cannot begin to staunch fraud losses in any
significant way unless their employers invest
in Artificial Intelligence (AI) technology. This
technology which gives investigators the
ability to process and analyze the incredible
amounts of data that is available about
claims, claimants, various third parties,
providers, and all the individuals involved. "

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