White Paper

The New Face of Insurance Fraud Looks Just Like a Legitimate Claim

Today’s most costly insurance fraud schemes don’t look suspicious — they look legitimate, and that’s exactly what makes them dangerous.
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White Paper Summary

Every week, my team reviews claims that look, on the surface, like open-and-shut cases. The injury is plausible. The treatment records are in order. The documentation is clean. And increasingly, that’s precisely the problem.

The question we’ve had to learn how to ask is whether it’s actually real or just posing as legitimate enough to move through the system. In today’s fraud environment, the line between the two is blurring fast.

I’ve spent most of my career in technology and analytics, and I’d argue that the current moment is the most consequential shift I’ve seen in how fraud operates. Three forces are converging at the same time: AI tools that make document fabrication inexpensive and convincing; digital claims workflows that compress the window between submission and payment; and increasingly coordinated fraud networks that have mapped the detection gaps and built their schemes around them.

To learn more about Travelers, please visit their website.

The Travelers Companies, Inc. (NYSE: TRV) is a leading provider of property casualty insurance for auto, home and business. A component of the Dow Jones Industrial Average, Travelers has approximately 30,000 employees and generated revenues of approximately $28 billion in 2016. For more information, visit www.travelers.com.

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