MetLife Auto & Home Puts Brakes on Fraud with CSC’s Fraud Evaluator
Client:MetLife Auto & Home
- Detect fraud as early as the first notice of loss without disrupting claims process
- Develop Fraud Evaluator, which flags suspicious claims and incorporates predictive modeling and identity search technologies
- Increased investigations by 16%, uncovered fraud
- Returned much of investment – within six months
MetLife Auto & Home wanted to keep its claims process moving smoothly, while putting the brakes on fraud. To aid its special investigations unit (SIU), the company helped develop technology to ferret out medical provider, attorney and repair shop fraud.
16% Increase in Investigations in Six Months
The company looked for a software tool that would flag suspicious claims and incorporate predictive modeling — a statistical technique based on historical instances of suspicious claims — as well as identity search technology. The carrier teamed up with CSC to co-develop a new system, Fraud Evaluator, formerly named @First, which increases the quality and speed of referrals to the SIU. In the first six months of full production with Fraud Evaluator, the software accounted for 22 percent of the referrals investigated by the SIU and the number of claims under investigation grew 16 percent.
Significant Return on Investment
In six months, the company realized a significant return on its investment. Fraud Evaluator flagged claims involving medical providers, attorneys and repair shops suspected in multiple incidents of fraud. It identified one insured with four active claims — three of which were for car theft. In another case, an agency with a high loss ratio was added to a watch list. Within weeks, Fraud Evaluator began flagging suspicious claims with similar characteristics — hit-and-run accidents, the same medical provider and the same agency.
Next Level: The Underwriting Process
Fraud Evaluator monitors claims files throughout the life of each claim. Even if the claim doesn’t have enough information to be flagged as suspicious when it is filed, as claims data is added throughout the investigation, the claim is continually re-scored. Fraud Evaluator also has the ability to improve the underwriting process by scanning new business applications. “CSC’s ideas for developing the system basically fit everything that we had wanted,” said John Sargent, SIU manager for MetLife Auto & Home. “It was our wish list.”