Breaking the Limitations of Traditional Risk Assessment with Pre-Check

Claims adjusters at insurance companies are often in the business of making suboptimal tradeoffs. In order to manage caseloads, they have to make time-sensitive decisions, while simultaneously flagging potential instances of fraud or malingering.

Unfortunately, due to data silos and time and resource constraints, adjusters generally lack the ability to consider flags outside of standard case data and documentation, which are typically provided directly by the claimants or insureds. While certain adjusters’ deep experience or keen intuition can help plug the holes, the right technology can instantly enable adjusters across all experience levels and lines of insurance to access broader datasets, quickly spot red flags, and save the organization time and money.

Skopenow works with a number of large insurance carriers to support automating fraud and risk signaling at scale with Pre-Check. To better understand and illustrate the complexities of this issue, we spoke with real end-users from the claims and SIU department of a major insurance carrier before and after adopting Skopenow's Pre-Check, a purpose-built solution for clerical teams, claims staff, SIU investigators and analysts, and management across all functions and levels.

During the course of customer interviews, it became clear that the claims handlers previously relied on time-consuming, inaccurate, and manual methods to assess claims. Handlers were asked to use their intuition and experience when manually reviewing a claim for legitimacy, with the added challenge of only having access to the limited information provided by the claimant.

To reduce and eliminate reliance on time-consuming, manual methods with an overly narrow view of claims, we first wanted to understand the type of information that adjusters typically have at their disposal.

Surface Level Insights

When an adjuster starts a typical case review, they often have access to disparate, narrow pieces of information to aid their decision-making. That may include the:

• Claim Form: The first document a claims handler will typically see, which includes basic information such as the policyholder's name and policy number, details about the loss or damage, and the date and time of the incident.
• Policy Details: The claimant's policy documents to determine what is covered under the policy and what the policy limits are.
• Supporting Documents: When they exist, these can include police reports, medical records, receipts, and other evidence submitted to validate a claim.
• Claim History: The claims handler can access the policyholder's claim history to look for repeat claims or patterns or inconsistencies in prior claims.

Our conversation with the Skopenow end-user revealed further insights into the challenges that claims handlers face when evaluating insurance claims, and how these challenges can be addressed with automation.

With Pre-Check, customers can automatically ingest and assess a variety of flags without human intervention.

• Insights
• Business Connections
• Connections via Link Analysis
• Public Records

The key component is open-source intelligence. Knowing the challenges claims adjusters face is an important step in developing new processes, but it’s also crucial to understand how publicly available information can address these issues and transform the way insurance carriers operate.

Pre-Check quickly and accurately identifies high-risk claims, enabling claims handlers to prioritize and focus their resources on investigations with the highest likelihood of producing results.

Scalable OSINT due diligence solutions hold the potential to transform insurance claims. By giving claims handlers access to a wealth of information beyond what claimants provide, they can make more informed decisions about a claim's legitimacy and alleviate the workload for investigators.