Costs for claims processing and resolution are on the rise, as providers increasingly struggle to combat fraud. Join Attensity’s James Purchase, Senior Director of Industry Solutions, to learn how Attensity’s Insurance Industry Solution helps insurance providers find cost-effective ways to identify fraudulent claims and customer pain points, improve competitive rankings, win new business and retain loyal customers.

1. Attensity Webinar Series
Customer Experience Management in the Insurance P&C Industry
With James Purchase, Senior Director of Industry Solutions, Attensity
#AttensityWebinar

2. Agenda
 Introduction to Attensity
 Insurance P&C - High Loss Ratio Challenge
 Insurance P&C - Benefits of Unstructured Claims Analytics
 Use Cases:
 Detection of Fraudulent Claims
 Accurate Identification of Subrogation
 Enhanced Claims Analysis
 Survey Verbatim Analysis
 Member/Non-Member Review Analysis
 External vs. Internal Review Analysis
 Social Media Buzz & Sentiment
 Insurance P&C Solution Deliverables – Summary & Conclusions
 Q&A

3. About Attensity
Help the world’s leading brands leverage
customer conversations as a business asset.
No matter where they take place:
social media • blogs • surveys • call center notes • review sites • emails • more
10+ years of experience in Text Analytics/CEM
7 patents in natural language processing
500+ installations worldwide
World’s largest NLP development group

4. We Work with the World’s Leading Brands
Customer
Service
BI Text
SCRM
Analytics
VOC

5. Attensity Social Analytics and Engagement Suite
Real-time annotated social
ATTENSITY COMMAND CENTER
media data feed: 75+ million
social and online sources
ATTENSITY
PIPELINE
Plus internal sources: emails,
surveys, CRM notes, etc
Enriches and
tags the data
Extracts people, ATTENSITY ANALYZE ATTENSITY RESPOND
Deep sentiment, root cause analysis and trending Social customer engagement solution
places, things,
events

6. Insurance Industry Solution
Built on Attensity Analyze:
First Text Analytics Solution Designed for Business Users
One of a series of industry solutions
 Includes out of the box:
 Industry specific Dashboards,
Reports, Categories, Topics
 Patented semantic analysis for
extracting detailed
insights from text
 Sentiment and
root cause analysis
 Trend analysis
 Continuously updated
social media feed &
market intelligence
 Point and click
wizard for creating
custom reports &
dashboards

7. P&C Industry - High Loss Ratio Challenge
 Most property and casualty (P&C) insurers ended 2011 with dismal financial
results, with many insurers experiencing year-over-year deterioration.
 Carriers are looking for ways to correct the High Loss Ratio!

8. Insurance P&C - Benefits of Unstructured Claims Analytics
 80% of all claims data is unstructured, which makes spreadsheet analysis
of standard data ineffective.
 Claims analysis of unstructured data can drive major financial
improvements in areas such as:
 Fraud
 Subrogation
 Provider Network
Management
Source:

9. Use Case: Improving Detection of Fraudulent Claims
 UK National Fraud Authority estimates £2 billion in fraud
annually.
 10% of all US P&C claims are fraudulent – representing
over $40 Billion of cost to the industry
 Industry best practice finds fraud in 1 to 3% of claims
 The Claim Adjuster workforce is aging: 70% is over 45
years old – knowledge and experience is leaving the
industry
 Average claim settlement times are too long, driving loss
and adjustment expense higher

10. Use Case: Improving Detection of Fraudulent Claims
Claims Administration
Straight through processing
Dictionaries Appropriate
Claim
Examiner
 Workers Compensation
 General Liability
 Auto
SIU
 Claims Database All data is Claims are
 Text Sources All claims are
fused
analyzed
assigned to 1 Intelligent Workflow
 Social Media together of 4 tiers
 Email
Supervisor
Other

11. Use Case: Improving Detection of Fraudulent Claims
Fused claim records:
Claims enter the funnel using filtering
options to identify claims to be processed Tiered Claims
claims in this tier show no suspicion and
Tier 1
should be fast tracked
No Suspicion
Tier 1
claims in this tier show minimal signs of
Tier 2
suspicion and may require analysis
Tier 2 Score
claims in this tier show stronger signs of
Tier 3
Tier 3 suspicion and should be analyzed
Tier 4
High Suspicion claims in this tier are highly suspicious and
Tier 4
should be referred to SIU
Actionable Claims

12. Use Case: Improving Detection of Fraudulent Claims
Reduced costs Addressing fraudulent claims earlier in the
process reduces the overall claims cost.
Training Text analysis uncovers inconsistent use of red
flags across claim examiners and identifies
training opportunities.
Improved regulatory Analysis of text identifies suspicious claims not
compliance reported to state agencies.
Knowledge capture Allows for the capture of fraud intelligence and
the consistent application across claims.
Provides a hedge against loss of knowledge .

13. Use Case: Improving Detection of Fraudulent Claims
Provides a cumulative view of
claims. In this example over
Drilling into this claim which is 50% of claims are
a Tier 3 we see the presence of characterized as :
4 indicators! Neck, Back, Shoulder, Arm &
Knee injuries!
Claims Details provides
additional information such as
Given that this is a Tier 3 claim Gender, Age, Health Profile…
we can update the status as
“Sent to SIU”
Many Red Flag Indicators are
publically known but many are
specific to a product/carrier
and others continue to emerge!
The presence of multiple Red
Flag Indicators can lead toshows a breakout of the
This
Fraud “Tiers”. The more
highest occurring flag
indicators present theindicators.
more
suspicious the claim!

14. Use Case: Accurate Identification of Subrogation
 Subrogation is the process
whereby one insurance company,
whose customer was not at fault,
recoups paid claims from the
company of the individual
responsible for the accident.
 Each individual state has unique
rules and regulations around what
constitutes “fault.”!
 For most insurance organizations,
subrogation is something less
than a science.
 Goal to quickly ascertain high
priority to low priority of
successful subrogation

15. Use Case: Accurate Identification of Subrogation
Attensity extracts Entities like
BODY_PART, CLAIM_ROLE &
INJURY but what about Attensity also gets to Subrogation and Root
relationships in text? Cause:
“insured vehicle : broadside : other vehicle”
“burn from airbag”

16. Use Case: Enhance Claims Analytics
Claims Supervisors can glean
intelligence about time-
intensive steps and consider
ways of improving claims
processing efficiency

17. Use Case: Enhanced Claims Analytics
Older claims may involve
multiple Adjusters. Individual
Claims Adjusters can review
chronological order of claims

18. Use Case: Survey Verbatim Analysis
 Members can provide feedback on themes such as Service, Attrition,
Product, Brand
 Indirectly there may be feedback on “Service Provider Networks”
including
 Body Shops
 Auto Repair Facilities
 Vehicle Rentals
 Legal Services
 Medical Providers.

19. Use Case: Survey Verbatim Analysis
Relatively higher Negative Negative feedback on Property
sentiment towards Property Poor communication/Follow-Up claims centered on “Policy
Claims process versus Auto is common to both lines of Coverage complaints”, “Poor
Claims process business Explanations”
“Claim Process Slow”
Auto Claim complaints are more
centered around
“Appraisals/Estimates Inaccurate”
Common Positive Sentiment towards
“High Or Increased Rates”lines of business includes:
both
“Performed Job Well”
“Helpful, Responsive”
Can review surveys for feedback on
Service Network Providers. Based on
quantity of feedback, there may be
opportunities for expanding
networks…

20. Use Case: Member/Non-Member Review Analysis
 Within most industries Member/Non-Member reviews are an
increasingly important component of “Word of Mouth” marketing
 Review sites controlled or facilitated by a carrier may tend to be more
positive in nature!
Reviews of USAA insurance products
and services were analyzed by 3 lines
of business: Auto, Home and Rental.

21. Use Case: Member/Non-Member Review Analysis
Reviews for Home insurance is
significantly more Negative
than Auto or Rental
Lots of Negativity towards
“premium”

22. Use Case: Member/Non-Member Review Analysis
Drilling down into Auto
Reviews we actually see some
Churn Threats!
These reviews can be routed
and responded to via Attensity
Respond!

23. Use Case: External vs. Internal Review Analysis
Specifically members/non-
External reviews show more members are complaining more
negativity about Service issues
Carriers that have a Social
Media Engagement strategy
are better placed to engage
with members!

24. Use Case: Social Media Buzz & Sentiment
Despite a lot of Negativity
towards Marketing
(commercials), YTD there is
more positivity
This report tracks Share of
Voice across Carriers
This report tracks overall
This tag cloud track overall
Sentiment across carriers…
specific complaints across
industry.

25. Use Case: Social Media Buzz & Sentiment
These reports provide a high
level and detailed view of
Sentiment across the entire
industry!

26. Use Case: Social Media Buzz & Sentiment
Through the use of Hotspots,
Attensity can track new
Product Launches, Marketing
Campaigns , Customer Service
and many other themes

27. Use Case: Social Media Buzz & Sentiment
Distribution of Social Media
Content Type By Carrier!

28. Use Case: Social Media Buzz & Sentiment
Sentiment by Social Media
Channel!

29. Insurance P&C Solution – Summary & Conclusions
 Packaged Insurance P&C Dictionaries, Topics, Categories, Reports &
Dashboards
 Tiered-Fraud approach – tiering of claims based on years of human
intelligence versus statistical and probability-based scoring
 Higher degree of accuracy – industry leading Text Analytics engine
enables a scoring approach that significantly reduces false positives and
negatives
 Easily configurable dashboards
 Over 100 OOB dashboard reports across Fortune 500 Carriers
 Daily extractions of all Social Media data (real-time available if needed)