Law, order and advanced analytics

By Donna Carbell
Head of Group Benefits
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Technology is changing the way we detect inappropriate claims

You may have read stories in the news about robots being used by police forces. In some cases, the bot cops are doing routine patrols, freeing up time for human officers. In other instances, the robots are designed to take on much more dangerous roles, including bomb detection and disposal. While the benefits industry isn’t using robots and technology in such dramatic, action-movie-like ways, we’re having great success using tech to wage the fight against fraud.

Fraud prevention month

March is Fraud Prevention Month. It’s the month when concerned organizations increase their efforts to help educate Canadians about the risks they face, and the steps they should take to protect themselves from fraudsters, scams, and schemes.

We’re all vulnerable. Who hasn’t heard stories about individuals, organizations, corporations, and even governments that have fallen victim to fraud? It’s disturbing to learn that, since the pandemic began early last year, there’s been a whole new wave of fraud directly related to COVID-19. Whether the crime involves large sums of money or seemingly small amounts, one thing is certain: it’s never acceptable when people are hurt, financially or otherwise, by parties who knowingly deceive organizations or individuals for their own personal gain.

The Canadian government has identified fraud directly related to the COVID-19 pandemic:

Between March 6, 2020 and January 10, 2021

  • Reports of COVID-19 fraud: 10,237
  • Number of Canadian victims of COVID-19 fraud: 8,583
  • Amount lost to COVID-19 fraud: $7,000,000

Source: Canadian Anti-Fraud Centre

In group benefits, I believe we’ll ultimately win the battle against fraud when every single plan member understands the value of their plan, how it works, and when we’ve instilled in them a sense of ownership for the long-term sustainability and success of their plans. As with most things, I think the more a person cares about something, and understands the value it delivers to them, the more likely they are to protect it, use it appropriately, and speak up when they see or sense something that isn’t quite right.

Technology for good

While plan member education and plan design are always going to be the cornerstones of any fraud prevention strategy, some really great progress is being made thanks to powerful new tools that can help spot fraud and stop inappropriate claims.

We’re all familiar with ways technology can be used maliciously (think of identity theft, data hacking, ransomware and so on). So, it’s natural that we might start to think of technology as the problem. It’s not. In fact, technology is a much more powerful tool for good – in this case – prevention.

One example: at Manulife, we run 100 per cent of claims through our advanced data analytics tools. Drawing from our millions of transactions, we’re able to score every claim, looking for patterns, triggers, red flags and other signs signaling the need for intervention or investigation.

Impossible no more

Not long ago, it would have been impractical (and impossible) to give every one of the almost 250,000 claims we process every day the degree of scrutiny we now perform in real time, through automation. Thanks to advanced analytics, our team is more effective and can spend its time focused on situations that warrant extra attention and investigation.

As a result, we can predict and trigger reviews before the claim is paid. We can manage providers if we have concerns about their business practices*, and we’re better able to identify areas of abuse within a plan. This helps protect the plan from inappropriate claims and payments, while helping to build a sustainable benefit program for your employees.

I’d love to be able to predict that someday benefits fraud will be a thing of the past. For now, it continues to require a constant, sustained, and energetic effort on behalf of insurers, banks, governments, employers and individuals to stay a step ahead. I’m confident though, that by bringing data analytics and other innovations into the effort, we’re advancing not just by steps, but by long, super-robot-like strides. And we have the data to prove it!

Learn more about Manulife’s fraud prevention efforts:
Check out the Canadian Life and Health Insurance Association’s “Fraud = Fraud” campaign.
*These business practices may include submitting improper claims, potential benefits abuse, or disciplinary action taken by a regulatory body.
More from Donna Carbell: In this post, Donna discusses a recent surge in requests for online mental health support and the rise of digital therapy.