Insurance Fraud: Detection & Prevention Techniques

Broadcast Date: Tuesday, May 24, 2016 from 12:00 pm to 2:00 pm (ET)
J. Michael Skiba, MBA, PHD
Robert J. Bodoni, CIFI, FCLA, AIC, AIS
Sally Welsh



RiskShield from INFORM assesses the potential for claim fraud at first notice of loss, medical billing fraud, and performs risk assessment within insurance application data. Finally, working with our customer’s internal management systems, RiskShield can optimize the entire claims process from start to finish allowing clean applications, bills, and claims to flow smoothly and quickly through the system ultimately providing positive customer service. 

With a predictive approach, RiskShield incorporates time proven methods such as fuzzy logic, pattern recognition, business rules, and the use of both internal & external data sources to score claims quickly and effectively resulting in valuable insights of fraudulent behavior. Sounds complex to maintain, but RiskShield’s rules can actually be created, tested, verified, and deployed in real-time by fraud specialists of insurance companies themselves without any vendor support, IT support, or system downtime. 

Overseeing our core processes, RiskShield’s Business Intelligence dashboard can be configured to analyze active alerts & key performance indicators to uncover hidden patterns or unusual behavior ultimately maximizing our customer’s fraud detection performance and minimizing the number of false positives. Canned & ad-hoc report management can then provide reports as desired by our customers.

RiskShield is used in more than 25 insurance companies currently in Europe and North America, protecting some of the world’s largest insurers, including AXA, GEICO, and Zurich with many of our customers experiencing ROI return rates up to 7:1 per annum.

For more information, call us at 949-293-2793 or send an email at


About MetLife

MetLife, Inc. is a leading global provider of insurance, annuities and employee benefit programs, serving customers in nearly 50 countries.


About Ernst & Young LLP

Dealing with complex issues of fraud, regulatory compliance and business disputes can detract from efforts to succeed. Better management of fraud risk and compliance exposure is a critical business priority — no matter what the industry sector is. With over 4,500 fraud investigation and dispute professionals around the world, we can assemble the right multidisciplinary and culturally aligned team to work with you and your legal advisors. We work to give you the benefit of our broad sector experience, our deep subject matter knowledge and the latest insights from our work worldwide.