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THE CHALLANGE: Insurance Fraud Continues to Rise: Costing U.S. Carriers $30 Billion Annually


According to the Coalition Against Insurance Fraud, 2018 was the third consecutive time in six years that insurers reported increasing amounts of fraud. Nearly three-quarters of insurers reported that fraud had increased either significantly or slightly, an 11-point increase since 2014.

To address the issue, 87% of carriers are investing more than $5 million in AI every year. This is more than both banking (86%) and consumer goods and retail companies (63%).

Two practical applications for this technology – claims and underwriting fraud – provide opportunity to help solve some of the industry’s biggest challenges. AI’s power to help combat fraud is its ability to analyze mass amounts of data from a wide range of sources including previous claims, customer information, and social media.

A senior data scientist at AXIS Capital recently noted that 80% of internal data is unstructured in the form of PDF and emails, and that AI’s text mining and natural language processing could help reveal core hidden information. Additionally, AI can scrape information from the Internet, gathering data in real time to understand evolving risks.

issuance challenge

RadianceSM

Radiance is a deep-web listening tool that uses machine learning and artificial intelligence to assess and prioritize risk.

Radiance scours publicly available data across the entire Internet, correlating names entered into the system with content related to 25 different risk factors, known as Behavioral Affinity Models (BAMs), and cross-referenced with more than 1 million queries into Lumina’s proprietary databases of risk.

Searches provide near-instant results, delivering meaningful, actionable intelligence to identify and prevent risk.

S4SM

The S4 app, a crowd-sourced, mobile application that allows users to confidentially report concerns in real time.

THE SOLUTION: Using AI-Driven Technology to Prevent Fraud and Identify Risk


Radiance is a powerful tool to help identify potential fraud and other concerns. It ingests and processes large amounts of unstructured data, providing actionable, prioritized results that can be further refined by entering publicly-available identifiable information.

Radiance includes more than 3,500 terms related to risk, fraud and other industry concerns. The platform conducts more than 70,000 searches across all publicly-available data on the web, correlating names with these terms and cross-referencing over 1 million queries into Lumina’s proprietary databases of risk. Unlike social media monitoring, Radiance is not reliant on a single platform or social media API, allowing for the continuous ingestion of all open source data. Radiance pulls all applicable content into a comprehensive report. The results are prioritized, making it easy to further analyze the findings and determine potential risk. A manual web search of this magnitude would take more than 7 months for one person to complete.

S4 app can be configured as a workplace tool, allowing employees to report ris fraud in real time. A centralized management portal allows clients to access real-time threats to geo-fenced facility locations.

issuance solution