1. Fraud Risk Management at Digital Insurance Market
October 6, 2016
İstanbul
©2016 SİSEB, All right reserved.

2. Digitalization
Yesterday
Today
©2016 SİSEB, All right reserved.

3. SİSEB’s Objectives
To manage organised, systematic fraud risks on behalf of the insurance market…
To be ‘centre of excellence’ for fraud data sharing…
To create new infrastructure to enable the insurance market to consistently share intelligence…
©2016 SİSEB, Tüm hakları saklıdır.
©2016 SİSEB, All right reserved.

4. Aims Coordination Dashboard Awareness Cooperation
Decreasing financial losses
©2016 SİSEB, Tüm hakları saklıdır.
©2016 SİSEB, All right reserved.

5. Strategy ... ... ... ... 2017 2016 2015 Claim files sharing by daily
Dashboard
SİSBİS projects
Awareness traniee
Social Media Analytics
Analysis for the other LoB
Special investigator data
Website
...
Customer scorecard
Repairshop scorecard
Corporate communications
Analytical decision machine
Crime line
Law processes and cooperations
...
...
...
2016
Bureau was established
Completion of pilot study for analytic models
©2016 SİSEB, All right reserved.

6. Insurance Fraud Problem
Sharply Increases
Results for the first 9 months of 2016;
100%
259 Mio TL
All Claims
Fraud detection
10-25%
Fraud detection 0%
©2016 SİSEB, All right reserved.

7. Effective Fraud Risk Management
Insurance Companies
Strategy
Policy
Common Language
Risk Analysis
Control Activities
Data Mining
Awareness
Monitoring
Following
Insurance
Company
Channel
Management
Process
Management
Communication
©2016 SİSEB, All right reserved.

8. Performance Management
Strategy
Detection
Investigation
Prevention
Fraud indicators,
Fraud coordinators,
Fraud dashboard
Dedicate team,
Detection system,
Analysis of social network
Fraud unit,
Coordinating with other departments
Skill building
IT systems
Organizations
Performance Management
©2016 SİSEB, All right reserved.

9. Key Performance Indicators
% of detected suspicious claims and/ or policies
Fraud savings in terms of % (all claims values)
Cost of detection and investigation (% of savings)
Time required for above process (per case)
Number of false positives
% of justified client complaints
©2016 SİSEB, Tüm hakları saklıdır.
©2016 SİSEB, All right reserved.

10. Return on Investment ROI= Evaluating the effiency
Comparing the effiency of a number of different investment
Gain from Investment – Cost of Investment
ROI=
Cost of Investment
Source: Investopedia
©2016 SİSEB, All right reserved.

11. KPI’s & ROI Who is responsible for KPI’s and ROI?
How many cases are digestible by the system?
Is a certain % of gained savings invested back in fraud detection and prevention?
Are diligent employees rewarded beyond salary (in processes before SIU engagement)?
©2016 SİSEB, All right reserved.

12. Policy Governance Assessment Investigation Awareness Fraud Committee
Fraud policy
Regulation and Legislation changes
Cooperation with law enforcement
Identify potential fraud
Control Gap analysis
Anti fraud handbook & procedures
Monitoring
Staff training
Fraud manual
Reporting process
Detection and prevention
FNOL
Business models
Case management
Criminal complaint and report
Governance
Assessment
Investigation
Awareness
©2016 SİSEB, All right reserved.

13. Awareness Policy, procedures, workflows, E-learning tools, platforms,
Seminars, webinar, online conference
Online events and website,
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14. Common language, common sense, common vision...
Network
Coordinate
Cooperate
Colloborate
Exchange Information
Exchange Information
Exchange Information
Harmonize Activities
Exchange Information
Harmonize Activities
Harmonize Activities
Share Resources
Share Resources
Enhance
Capacity
©2016 SİSEB, All right reserved.

15. Channel Management
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16. Risk Analysis FRAUD RISK Pressure Opportunity Rationalization
Motivation or incentive to commit fraud
Opportunity
Ability to carry out misappropriation of cash or organizational assets
Pressure
Opportunity
FRAUD RISK
Capability
Rationalization
Rationalization
Justification of dishonest actions
Capability
Knowledge of systems
Skills required to undertake

17. Insurance Fraud Problem
Control
Activities
Daily what if scenarios,
Weekly, monthly, quarterly reports,
Build and track specific metrics,
Track fraud trends, patterns closely,
Quantify using scorecards,
Review the using models.
©2016 SİSEB, All right reserved.

18. Following Automated scoring system Automated detection systems
Special business rules
Automated detection systems
Red flag systems for each LoB
©2016 SİSEB, All right reserved.
©2016 SİSEB, All right reserved.

19. Monitoring Data mining Proactive Analysis Social network analysis
Systematic analysis database
Predictive modelling
Decission tree analysis
Data mining
Social network analysis
Text mining
Picture mining
©2016 SİSEB, Tüm hakları saklıdır.
©2016 SİSEB, All right reserved.

20. Process Management Reporting Repository Data Staging Case Management
Alert Rules Repository
Fraud Rules Repository
©2016 SİSEB, All right reserved.

21. Data Mining Anomaly Detection / Business Rules Predictive Analytics
Text Mining
Prefill data update detection
Social Network Analyzer
Link Analysis
Industry Database Lookup
Telematics
Voice Analysis
Image & Video Analysis
©2016 SİSEB, All right reserved.

22. Fraudulent Behaviour Contract conditions, Customer experience,
Shaped expectations,
Ethical climate ,
Customer communications,
©2016 SİSEB, All right reserved.
©2016 SİSEB, All right reserved.

23. Communication
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24. Customer Experience at Fraud Management
Satisfaction
Loyalty
Suspicious and Fraud risk F
©2016 SİSEB, Tüm hakları saklıdır.
©2016 SİSEB, All right reserved.

25. SİSEB-Fraud Management
ALERT & CASE INVESTIGATION
BUSINESS INTELLIGENCE
LOGIC
REAL TIME
DETECTION
RULE MANAGEMENT
HISTORICAL DATA & EXTERNAL RESOURCES
DYNAMIC PROFILING
HIGH PERFORMANCE PROCESSING
©2016 SİSEB, All right reserved.

26. Thank You
Every fraudster leaves a footprint and that footprint is in the data!
©2016 SİSEB, All right reserved.