At Erie Insurance Group, the foundation for fighting fraud is a business strategy that defines objectives, quantifiable goals, and tactical and operational plans: What is the company trying to accomplish? Does the company have enough resources to react to instances of fraud? How is Erie going to get better referrals to its special investigations unit and become more proactive in identifying fraud?"Erie is keenly aware that our experienced people-our claims adjusters, field investigators, intelligence analysts and information specialist-coupled with our use of fraud detection technology and investigation tools, have made our anti-fraud program so successful," says David Rioux, assistant vice president and manager, corporate security and investigative services for Erie Insurance Group, Erie, Pa.
Rioux, who oversees a group of more than 50 investigators, intelligence analysts and information researchers, believes that technology enables his staff to be more effective and efficient at the work they do. The process starts with a predictive modeling product called FraudFocus developed by Magnify Inc., Chicago. Every day, all Erie claims are scored using a combination of the company's historical data and industry indicators. Suspicious claims are red-flagged and referred to field adjusters. If the claim warrants further investigation, it is sent to fraud investigators.
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