SAS Analytics, Case Management To Fight and Prevent Fraud 
Worldwide, companies are adopting analytics to bring to life the phrase “a penny saved is a penny earned.” One of the largest financial firms in the U.S. will use SAS Enterprise Case Management to fight criminal and fraudulent activities, and a major Korean insurer is deploying SAS to prevent claims fraud.
Companies worldwide are adopting analytics to bring to life the phrase “a penny saved is a penny earned.” One of the largest financial firms in the U.S. will use SAS Enterprise Case Management to fight criminal and fraudulent activities, and a major Korean insurer is deploying SAS to prevent claims fraud.
In the U.S., BB&T, which manages more than $157.2 billion in assets, is turning to SAS to improve and automate many risk management processes to more quickly track down and stop offenders. BB&T already uses SAS software for customer intelligence, anti-money laundering and credit risk management, according to officials.
SAS Enterprise Case Management, part of the SAS Enterprise Financial Crimes Framework, includes historical versioning, social network analysis integration, Web service search and event notification, according to the company. Using historical versioning, investigators can easily see up-to-the minute changes made in the case system.
The latest version of SAS Enterprise Case Management streamlines processes and investigations, helping organizations save money and better prevent fraud, according to SAS officials. The system also includes a detailed audit trail, that will track changes in phone numbers, e-mail addresses, and addresses. It also provides “social networking analysis and visualizations” that will allow investigators to view networks of individuals related to any case.
“Besides contributing to risk management, today’s leading case technologies can also help institutions tie their policies to operational performance, reduce operating costs, and even grow the business,” said Rodney Nelsestuen, Senior Research Director at TowerGroup, in a statement.
Inside Korea’s Hyundai Insurance’s Plan
To Use Analytics To Catch Crime Before It Pays
Meanwhile, Hyundai Marine & Fire Insurance Co. Ltd., Korea’s largest non-life insurer, is using SAS to launch a new fraud detection system, which will also be able to help the company actually improve services for the company’s best customers.
With SAS, Hyundai M&F’s fraud detection will provide “predictive” models to help Hyundai M&F claims investigators better detect insurance fraud not just after it occurs, but in time to prevent a fraudulent claim from being paid. Components of the solution include:
- Business rules (based on the experience and knowledge of its investigators)
- Model rules (created from data extracted from various IT systems)
- Correlation capabilities based on SAS’ advanced statistical techniques, and
- Ability to deliver results to claims investigators in real time.
The Hyundai M&F system will also monitor how these rules perform, so the company can quickly change its existing rules or create new ones.
“With SAS providing the foundation for advanced insurance fraud management, we can maintain consistent and transparent criteria for investigation, automate the scoring system, and respond swiftly and flexibly to investigations and operations of the organization,” said Cheol-woo Lee, the Hyundai M&F Claim Investigation Department team leader who oversaw the project, in a statement.
The predictive outcomes provide Hyundai three key benefits:
- A fraud pre-detection system based on statistics-based model rules and business rules to help investigators determine what activities might be fraudulent;
- A fraud post-detection system to detect afterward the characteristics of certain groups not detected with the prejudgment model; and
- A risk mart to generate data for prejudgment and post-judgment models.
The project also contributes to increased accuracy of fraud detection without increasing the number of investigators.
