What are the main areas in which insurance fraud (and fraud management practices) have been developing in recent years?

In recent years, the Fraud Awareness has increased significantly. The Insurance Industry has understood that the losses which arise from fraud are huge and have a strong negative impact on the business operating profit BOP. On the other hand it became clear that sophisticated fraud prevention improves the combined ratio by important one to three percentage points!

To what extent have new technologies been able to improve managing insurance fraud? Have they also allowed fraud to become prominent?

In addition to the traditional methods of fraud detection, such as training of claims handler and loss adjuster, more emphasis is placed on the technical support to increase the fraud detection rate, to decrease the false positives and to streamline the claims processes. Meanwhile most of the insurers have understood that without sophisticated automated fraud detection, in-depth data analysis and innovative software tools like meta search engines, fraud fighting will continue to be costly and will be a fight with no reasonable chance to win.

How is fraud data processed and utilized in order to improve fraud prevention?

Therefor it needs a holistic view on overall claims data. We should see automated fraud detection as a claims process optimization service which increases operational effectiveness and decrease loss exposure and risk. The feedback/info-loop to risk management and underwriting must be an integral part of this. Data analytics is key to detect future fraud trends at an early stage.

How prominent has cross-border fraud been in the last few years? What are the most important aspects thereof?

Unfortunately, the criminals can defraud across borders without major problems. They operate freely organized and foreclosed across countries. Local law enforcement and local Insurers are bound by the local laws and are struggling to stop this phenomenon of international crime. Here, the insurance industry must cooperate much more in between the organizations and accelerate the collaboration with European and International institutions such as Europol and Interpol.

However, this is still a challenge and a long and stony road.

Courtesy to the Fleming Team

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Roland WOERNER held several management roles of various Specialized Departments at law enforcement Germany and Latin America.

From 1990 he worked as a criminology / criminological advisor of Gerling Consulting Group and implemented as a result the central fraud prevention of the Gerling Insurance Group.

In early 2007 he founded the department of fraud prevention at Generali Germany Claims Management GmbH and took the lead as Head of Fraud Prevention.

In 2009 Roland joined Zurich. He developed and defined the global counter fraud operations strategy across the Zurich Group, established the global framework and implemented a best practice model for claims counter fraud. His team reduced operational costs and mitigated fraud losses significantly. He built the confidence of the board and all key stakeholders and ensured there is global alignment and buy-in to the overall group wide anti-fraud strategy and roadmap.

Roland is founder and owner of WoernerConsult GmbH., a management consultancy.

Roland is lecturer at the School of Criminal Investigation and Forensic Science (School CIFoS), Berlin, Lecturer at the CBS Cologne Business School and Guest-Lecturer at the University Zurich. He is member of the German Society for Criminology (DGfK), member of the Association of German Police Detectives (BDK) and member of International Association Special Investigation Unit (IASIU).

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