How know-how adjustments fraud, with Matthew Smith (podcast)


Expertise may help insurers streamline the shopper expertise—however it additionally opens the door to new sorts of fraud. Matthew Smith, The Coalition Towards Insurance coverage Fraud, on what needs to be in an insurer’s fraud detection toolkit.


Expertise just like the Web of Issues, and particularly linked house and automobile, are enabling investigators to recreate an individual’s digital path—and together with huge information, to create a digital mosaic that may gasoline insurers’ fraud investigations.
On the identical time, shopper rights to privateness and cyber safety are paramount, and insurers should function inside authorized and regulatory limits, in addition to moral and ethical boundaries.
An efficient anti-fraud plan encompasses all features of the insurance coverage firm, not simply the claims perform—and is particularly vital as insurers attempt to offer sooner, extra seamless buyer experiences.

Insurers should embrace new applied sciences to guard their firm and its policyholders, as nicely set up the ethics, morals and finest practices for a way these applied sciences will likely be used.

How know-how has modified fraud, with Matthew Smith

Matthew Smith is the director of presidency affairs and basic counsel for the Coalition Towards Insurance coverage Fraud. He additionally has almost three many years of expertise in insurance coverage legislation.

In our earlier episode, Matthew talked in regards to the demographics of who commits insurance coverage fraud—and the stunning the reason why they do it. On this episode of the Accenture Insurance coverage Influencers podcast, he shares how know-how helps insurers battle fraud—and the way concurrently, the pattern towards frictionless buyer experiences is opening the door to new sorts of insurance coverage fraud. Lastly, he gives steering for insurers seeking to shore up their fraud detection toolkits.

The next transcript has been edited for size and readability.

Earlier, we talked about how fraud has shifted over time, and one of many adjustments was know-how and the flexibility of insurers to make use of it to raised examine and battle fraud. I perceive that you simply’re a little bit of a pioneer in that respect, notably utilizing information from cellular phone towers to collect proof for insurance coverage fraud circumstances, in addition to utilizing social media searches. Why are developments like this vital for the fraud detection business?

They’re extraordinarily vital. I feel that we’re on the tip of the iceberg proper now when it comes to the place know-how goes to guide us over the following decade or most likely twenty years. As I alluded to earlier, the know-how we have already got in place at this time would have been Star Wars know-how, even again within the 1980s and early 1990s.

There’s a program I’ve the privilege of instructing and it’s known as, “The place’s Waldo and what’s he as much as?” In that program, we’re capable of present fraud investigators and folks taken with insurance coverage fraud that all of us depart a digital path behind us. That path permits an investigator to go in and know precisely the place we have been and what we have been doing yesterday.

We are able to return and we are able to construct a mannequin. GPS, loyalty playing cards, when individuals cease at a financial institution and take cash out of an ATM, when individuals undergo a toll plaza and use a toll reader, or when individuals go into their enterprise and scan in with an worker ID, that leaves a digital footprint.

We’ve got the flexibility to make use of these digital footprints to return and confirm whether or not somebody’s timeline—of the place they are saying they have been, what they are saying they have been doing—matches up with what they’re asserting, and the proof regarding the declare.

Then you definitely couple that with the flexibility to scrape information or pull information. We are able to decide who somebody communicated with, the place they made purchases, when these purchases have been made, and put all of that collectively right into a digital mosaic––it permits us to have far more capability to precisely decide the place somebody was, what they have been concerned in and whether or not or not they could have been concerned in committing the insurance coverage fraud.

That’s fascinating and in addition from a private perspective, barely formidable to be residing at a time if you create that digital footprint simply by your on a regular basis strikes. After which we’re one thing just like the Web of Issues and linked automobiles and wearables. How do these play into the dialog?

You recognize, the Web of Issues goes to really be fascinating as we see this unfold. However let me offer you a real-life instance already of the place it’s changing into actuality. Right this moment we’ve got already fridges, washers and dryers which have Web connections. So think about the flexibility, when that machine in your house is sending continually information, speaking with different gadgets on the Web of Issues.

For instance, you allege that you weren’t house yesterday between midday and four:00 p.m. when the hearth occurred. By pulling the information, we are able to discover out that at 2:14 p.m., somebody opened and closed the fridge door. We are able to discover out that at three:15 p.m., a load of laundry was began. So all of those items that go into the Web of Issues, from Alexa to all the sensible house gadgets, all create a digital path.

There have been a number of fascinating circumstances. One was a homicide case in Arkansas the place they have been subpoenaing the data of the Alexa machine to see what Alexa could have heard main as much as the time of the homicide. Now that was a legal case, not an insurance coverage fraud case, however relaxation assured these are the cutting-edge circumstances which can be going to take us into the way forward for what insurance coverage fraud investigators will or won’t be able to realize entry to.

Wow. And the place does shopper privateness match into all of this?

In case you return to what I mentioned at first, the Coalition was shaped 25 years in the past by shopper advocates and insurers. Now we’re in a courageous new world as we take a look at the Web of Issues, as we take a look at all the know-how that we’ve talked about. However that must be balanced with defending customers’ rights of privateness and cyber safety.

Insurers have to research insurance coverage fraud, however accomplish that inside a really sturdy parameter of what the coverage of insurance coverage permits, what their state laws and state legal guidelines allow them to do, and what the moral and ethical boundaries are—as we as a society transfer into this new world of know-how, the Web of Issues, and the flexibility to have far more in-depth investigation of our private lives.

So one of many true missions now of the Coalition, is to be sure that we and our members are on the forefront of not solely recognizing and utilizing these new applied sciences to battle fraud, however that we’re equally the sturdy voice in main the decision to ensure it’s carried out in finest practices––and make sure it’s all the time carried out with the utmost of moral and ethical safety of the patron. And we’ve got to maintain that on the forefront.

Undoubtedly and a very good level. Now, I’m curious in regards to the stage of know-how that we’ve talked about at this time. Is that sometimes utilized by insurers to detect fraud? Or are they utilizing extra old-school strategies?

I feel we’re in a interval of transition and I don’t know that we are able to quantify and say it’s 60/40, 70/30.

One of many research that the Coalition does each few years is a know-how research as nicely, and what we’re seeing is that extra insurers are utilizing know-how to determine fraud. They’re beginning to use synthetic intelligence. They’re utilizing predictive modeling in order that they will take a look at and analyze, not solely an insurance coverage declare after it happens, but additionally within the underwriting section to attempt to stop insurance coverage fraud from ever occurring. Through the use of these new, rising applied sciences for higher underwriting practices that do embody anti-fraud elements.

So I feel you might be seeing insurers beginning, an increasing number of, to combine these new applied sciences into their underwriting, their claims and their fraud combating platforms. But it surely’s going to be a gradual transition going over the following decade forward, no less than.

Proper. And a whole lot of what we’ve talked about, and I feel what lots of people take into consideration when they give thought to insurance coverage fraud, is claims fraud. It sounds to me like there’s a push for fraud detection to maneuver earlier into the coverage cycle—to level of underwriting and even level of quote.

Completely, in any respect phases. And that’s certainly one of issues we do advocate, is that a true anti-fraud plan has to embody all features of any insurance coverage firm. It’s important to take a look at your agent community, you must take a look at inside fraud throughout the firm, you must take a look at underwriting fraud. Is that one that is securing that coverage an actual particular person or is it an avatar for another person? Or is it a stolen id of somebody that’s being utilized to buy that coverage?

Once we get into the declare section, if it’s a third-party declare, we have to analyze once more. Is that the actual claimant that was concerned in that accident or that incident? Are they fronting for another person? Do we’ve got dependable and correct data or have these been falsified? On first-party claims the identical components apply. So it’s all features of the insurance coverage course of that we take a look at.

I feel we’re at a really curious junction proper now, the place many insurers are making the shift to grow to be extra customer-centric. So we’ve talked about the usage of cell telephones and there’s this push to make the insurance coverage expertise as frictionless as attainable, as quick as attainable. What does that imply for fraud detection, if particularly you’re not coping with an individual nose to nose?

It’s very fascinating as a result of we’re in an period proper now the place we’ve got higher capability than we’ve got had, at any level in historical past, to research insurance coverage fraud. However on the opposite aspect of the equation, what you simply mentioned is strictly true.

We’re in a world of insurance coverage proper now that’s changing into so consumer-centric, particularly with the dramatic rise of millennials transferring into the insurance coverage market, and peer-to-peer insurance coverage, the place actually your entire insurance coverage course of, from software to underwriting to claims to claims fee, is completed on a wise machine. We’re transferring so quickly to course of claims.

In case you take a look at Lemonade, for instance, they boast that they’ve paid a declare in three seconds. And that’s all carried out with synthetic intelligence. Now they’ll declare they’ve algorithms in-built and packages in-built. However as different carriers transfer towards not utilizing human interplay, however utilizing synthetic intelligence and making an attempt to chop down on the processing time of claims, we’re going to have new alternatives for fraud.

There’s an advert being run proper now by a significant insurance coverage firm, and it says, “If you are able to do this…” and it reveals an individual taking a selfie, “then you possibly can submit your insurance coverage declare.” So we’re inviting individuals now to not have somebody exit and examine a automobile after it’s been concerned in an accident, however simply add photos of that automobile. Nicely, do we all know for a indisputable fact that’s the automobile that was concerned within the accident?

Or even when it have been, listed below are quite a few web sites that permit you to alter images to make it seem as if a wonderfully effective automobile has been concerned in a crash. So how we deal with these rising developments of insurers eager to be so quick in taking good care of the patron, and balancing that with the flexibility that folks should commit high-tech fraud, goes to be very a lot of a problem for business within the rising years.

These sound like some huge points arising from what might be a have to replace the insurance coverage business and its processes. In order insurers look to shore up their fraud detection toolkits—and we’ve talked about so many alternative issues that they’ve at their disposal at this time—what ought to they be specializing in with a view to set themselves up for achievement for the following 5 to 10 years? What must be in that toolkit?

The primary factor they want of their toolkit is to embrace the brand new applied sciences which can be on the market to guard not solely the corporate, however extra importantly to guard the corporate’s policyholders who put their belief within the firm. However equally in that toolbox, you’ve acquired to place in there ethics, morals, finest practices, and written insurance policies and procedures on how these new applied sciences are going for use. Issues like: who has entry to this information, how will the information be used, how will we share it with policyholders, what information we’re going to require them to current to us within the occasion that they make a declare? In order that every part is disclosed upfront very pretty, very truthfully and we all know the parameters of how we’re going to make use of these new applied sciences.

Once we speak with our service members, we speak to insurers about the necessity to embrace the brand new applied sciences which can be there. Use them to guard your policyholders and your organization, however make sure on the forefront of every part you do, you might be main with sturdy ethical and moral pointers—and speaking to your policyholders what you’re doing and the way you’re going to be utilizing this new information that’s rising, and that we’re gathering and utilizing to battle insurance coverage fraud.

Matthew, thanks a lot for taking the time to talk to us at this time.

Thanks. It’s been my privilege, my honor to be part of the podcast.


On this episode of the Accenture Insurance coverage Influencers podcast, we talked about:

The digital path that folks depart in at this time’s linked world. Together with information, it may well allow investigators to create a digital mosaic to raised detect fraud.
Advancing know-how and information should be used responsibly, with shopper privateness, information ethics and cyber safety at their core.
Anti-fraud efforts go far past the purpose of declare; they need to embody all features of the insurance coverage firm.
As insurers put together for a digitally pushed future, they need to embrace new applied sciences to advance their fraud detection capabilities—and incorporate ethics, morals and finest practices to be clear about how these applied sciences will likely be used.

For extra steering on a digitally pushed way forward for fraud detection:

That wraps up our dialog with Matthew Smith. In two weeks, we’ll communicate with Eric Joost from Willis Towers Watson in regards to the evolving position of the dealer, and why customer-centricity and threat administration go hand in hand. Till then, you possibly can meet up with earlier episodes of the Accenture Insurance coverage Influencers podcast. We spoke to Ryan Stein about how self-driving automobiles are difficult at this time’s insurance coverage guidelines and Lex Sokolin about how synthetic intelligence may change insurance coverage.

What to do subsequent:

Contact us in case you’d prefer to be a visitor on the Insurance coverage Influencers podcast.


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