How to Manage Fraud in Insurance Companies with SAP Solutions
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How to Manage Fraud in Insurance Companies with SAP Solutions

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SAP Fraud Management helps Insurance companies to optimize their combined ratio by identifying claim frauds and avoid payments on illegitimate claim requests.

SAP Fraud Management helps Insurance companies to optimize their combined ratio by identifying claim frauds and avoid payments on illegitimate claim requests.

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How to Manage Fraud in Insurance Companies with SAP Solutions How to Manage Fraud in Insurance Companies with SAP Solutions Presentation Transcript

  • SAP Conference for Financial Services 2013 / July 9-10, 2013 / London / UK How to manage Fraud in Insurance Companies with SAP Solutions Uwe Hofstaetter, SAP AG
  • Industry Data Emphasizes the Opportunity for Fraud Management Excellence “Total cost in the US of insurance fraud (non-health) is estimated to be more than $40 billion per year” Fraud Investigation is time consuming (Source: Federal Bureau of Investigation, US) “Insurance fraud has risen by 23% in the last 12 Month…. as a result, insurance fraud is estimated to now cost £2.1 billion per year. ” (Source: Experian Fraud Report 2012) “According to the Association of British Insurers, the sector is detecting more than 2,500 fraudulent claims worth £18 million every week”. (Source: Experian Fraud Report 2012) Source: Accenture global claims study (3000 personnel interviews) Historical fraud detection methods identify only 10% of fraud cases. In combination with post-payment identification only 5% of detected frauds are recovered. © 2013 SAP AG. All rights reserved. 4
  • What Does This Mean for Your Business?  How can we identify fraud before a claim is paid?  How can we improve the fraud investigation efficiency?  How can we keep track with changing fraud behaviors?  How can we reduce the false positive signals?  What is the best approach to automate the fraud detection process and predict the likelihood of fraud?  How do we manage to check all claims for fraud but ensure fast claim processing? © 2013 SAP AG. All rights reserved. 5
  • SAP Fraud Management for Insurance Prevent. Detect. Investigate. Monitor. Prevent Detect Monitor Investigate Powered by SAP HANA SAP Fraud Management helps Insurance companies to optimize their combined ratio by identifying claim frauds and avoid payments on illegitimate claim requests © 2013 SAP AG. All rights reserved. 6
  • Fraud Management Monitoring Prevention Detection Investigation Claim Handling & Settlement © 2013 SAP AG. All rights reserved. Fraud Monitoring & Performance Optimization Fraud Pattern Analysis Define Rules & Predictive Models Online Detection Alert Notification Setup Detection Strategy Calibration & Simulation Integration Configuration Platform SAP Fraud Management for Insurance A Closed-loop, Cross-Functional Process Mass Detection Inquire & Analyze Investigation Evaluation & Decision From Claim Notification to Claim Closure 8
  • SAP Fraud Management – Design & Setup Time How to detect fraud - it is your choice! Known Patterns Expert Knowledge Rule Creation Unknown Patterns Detection Methods Database Optional © 2013 SAP AG. All rights reserved. Detection Strategy Business Process Predictive Model Creation & Training Via SAP HANA Studio or SAP Predictive Analysis 9
  • Demo SAP Fraud Management for Insurance
  • Take home messages Closed-loop Fraud Processing Prevent Detect Investigate Monitor  Real-time & online Fraud Management  Optimized Investigation Seamless Integration into business processes  Any type of fraud (e.g. claim, sales, payments, …)  SAP and non-SAP Powered by SAP HANA Improve accuracy of detection  Combine rules & predictive analytics for detection  Real-time calibration and simulation with the power and speed of HANA
  • Thank you Contact information: Uwe Hofstaetter Uwe.Hofstaetter@sap.com