CSC has released two software tools that can help companies save money and streamline operations while fighting crime. @First is designed to provide insurance claims investigators with indicators of financial fraud, and PATRIOT Protector enables companies to comply with U.S. federal regulations and identify suspected terrorists or drug traffickers.

Both @First and PATRIOT Protector integrate sophisticated search techniques and incorporate technical advances in areas such as predictive modeling, rules-based best practice automation and Web services. CSC technologist Progress Mtshali developed the framework for integrating various analytic components for these two tools. For his efforts, Mtshali has been named by CSC’s Leading Edge Forum as a recipient of the prestigious 2003 Award for Technical Excellence.

These solutions not only leverage CSC’s vast experience providing packaged tools and IT integration services, they also enhance CSC’s global ability to deliver significantly improved financial performance. Although @First and PATRIOT Protector were initially designed for use by financial institutions, CSC executive vice president Joe Jensen says, "Any CSC sector can have access to these offerings, as their design adapts to use in any segment or division vertical."

Fighting fraud with advanced technology

Fraud continues to have a negative impact on the bottom line results of many companies and @First addresses this growing problem. According to the Insurance Information Institute, fraud costs insurers over $30 billion annually in the Property and Casualty insurance segment alone. For years, companies have tried to come up with innovative ways to detect fraud, especially when it comes to the area of claims and underwriting.

For insurance companies, the key to a successful fraud identification program is the early detection of fraud, followed by a quick, focused and comprehensive investigation. Mtshali says, "One thing that we have heard is that there are too many different systems and individual approaches that are being applied on a one-method-at-a-time basis. Each approach has its own capabilities and limitations. Our concept in response was to build a solution that our clients can plug multiple engines into."

Working with MetLife, one of the largest insurers in the industry, Mtshali designed and developed @First, a system that enables the access and integration of data from multiple sources. @First serves as a framework that integrates predictive modeling, data-mining techniques and rules-based analysis to detect fraud. The result is a solution that automates and streamlines fraud detection throughout the claims handling process and allows clients to select the technology that is to be deployed and integrated.

John Sargent, Special Investigative Unit (SIU) manager for MetLife Auto & Home, says, "What we needed was a system that would analyze all the data associated with a claim and determine if any of it matched or promoted new views or information. CSC’s ideas for developing the system basically fit everything that we had wanted. They provided a direct response to what until then had been our wish list. @First is something our SIU directors and managers have always wanted and could just never find."

Tom Barger, product owner for @First and PATRIOT Protector, says, "There is no one size that fits all. We have integrated what heretofore had been standalone approaches in the marketplace and have brought together an integrated, aggregated solution for customers. @First brings together a number of different approaches for detecting suspicious claims or fraud."

According to Sargent, MetLife expects to reduce fraudulent payments by an additional several million dollars per year through the use of @First. "@First objectively analyzes all of our claims without relying on the human factor, as in the past," he says. "This will allow us to better serve our customers while simultaneously lowering the overall costs and response time of claims processing."

Expanding into additional markets

Jensen says when measured against competing products, a key discriminator for @First is that "we went right for the earliest detection or identification point, and then made certain that the solution kept looking through the life of a claim. When you receive first notice is precisely when you want to take a look at it and take action on the situations representing the highest probability of success in pursuit. Other solutions focus on recovering after a claim has been settled or money has been paid, which is just plain too late." In fact, Jensen says MetLife has begun pushing the concept even further forward into the insurance management chain by focusing on fraud at the claims application stage.

Buoyed by this early success at MetLife, CSC is expanding the @First solution into additional markets. Jensen says a number of major insurers who are evaluating the auto component of @First are also interested in working with CSC to expand the technology into areas such as worker’s compensation and personal property insurance. In addition, he says CSC is looking outside of the property and casualty vertical and applying the technology to banking fraud, credit card fraud and health care fraud.

"We have companies in every FSG [Financial Services Group] vertical looking at it now," Jensen says. He adds that from a geographic and sector standpoint, @First is making inroads in Australia, South Africa, the United Kingdom, as well as CSC’s Credit Services and Federal groups.

Helping companies comply with regulations

CSC’s PATRIOT Protector is built on the same decision enablement framework as @First and utilizes the latest in search and identification technology. Shortly after September 11, 2001, Presidential Executive Order 13224 went into effect, requiring all financial institutions and service providers to ensure that they are not conducting business with suspected terrorists, drug traffickers or Specifically Designated Nationals. These entities must periodically check client lists against a frequently changed list that is compiled by the Office of Foreign Assets Control (OFAC). The list currently contains over 6,000 names and changes, almost on a daily basis.

Describing the origins of PATRIOT Protector, Mtshali says, "Initially we started working on @First to detect fraud, and while we were in the middle of building the product, a need arose from MetLife for a system to comply with Treasury’s OFAC requirements."

CSC project manager Kendal Ashworth characterizes PATRIOT Protector as "a regulatory compliance service that keeps you from doing business with bad guys." She says that apart from the possible fines and jail time that can be levied for non-compliance, there is also the issue of damage to corporate reputation. "Companies don’t want their names associated with doing business with terrorists."

PATRIOT Protector uses a scalable Web application framework that provides clients with a browser-based interface and reporting tool. It is Web-hosted by CSC’s state-of-the-art eHub managed services facilities to ensure a rapid turnkey implementation and seamless integration with core systems.

Mtshali says, "With PATRIOT Protector, we’ve taken full advantage of CSC’s eHub facility. This means that for customers, implementation turnaround time is very short. It puts them in compliance in a very short time — less than a month. When you automate the entire process, that means you can complete the process much quicker."

Like @First, PATRIOT Protector has gained significant momentum in the marketplace. Jensen says CSC is currently handling inquiries and evaluations from more than 90 companies in the United States across a wide range of industries, including banking, financial services, insurance and real estate.

Getting a good night’s sleep

@First and PATRIOT Protector can be used together, as standalone products or in conjunction with other CSC offerings. Jensen says, "These solutions enable CSC to take an unexpected burden off the shoulders of our user community."

"Our chief goal is to provide administrative solutions and cost containment tools and services that enable companies to remain focused on their core business," Jensen says. "No one in any CSC private sector market ever woke up one morning and decided ’You know, I need a good way to check for terrorists.’ Their core business is the production of policies, payment and service to clients. The main reason we took this on was because this is one of the things we can do for our clients to provide them a good night’s sleep."

About the Leading Edge Forum

The Leading Edge Forum (LEF) serves as "The Technology Voice of CSC" by providing thought leadership and a technology point of view for both the marketplace and CSC. The LEF’s programs and initiatives include in-depth technology reports, the LEF Centers of Excellence, which are dedicated to providing world-class IT service, and the Award for Technical Excellence, which is the most prestigious recognition for technologists at CSC. Established in 1989, the award recognizes valuable contributions to CSC’s clients and its own technical knowledge base.

Related Information:

Contact Us and Let Our Experience Help You Produce Results.

Visit CSC’s Financial Services for more information on @First and PATRIOT Protector.

Read the press release, "CSC Introduces Software to Help Combat Insurance Fraud."

Learn more about the Leading Edge Forum and the Award for Technical Excellence.