A day in the life of... a Fraud Manager

Following the success achieved by the Allianz Suisse team in their fight against insurance fraud, we spoke to one of the lead investigators in the team. Benjamin shared some of the fantastic achievements and best practices that the team have put in place after adopting Allianz’s Group Anti-Fraud Solution (GAFS) which has Quantexa as the group’s strategic fraud-fighting tool.

Hi, I'm Benjamin👋

Before I joined the SIU about 5 years ago, I had a variety of roles. I started my working career with an apprenticeship in a technical branch. I then went to the police academy to become a police officer for a decade. During that time, I started attending a university of applied sciences and 4 years later, I graduated with a Master of Law degree and passed the Bar Exam after two trainee-ships. After the Bar Exam I worked briefly as an attorney of law before joining the SIU at Allianz Suisse. 

To master the challenges of work, I like to challenge myself mentally and physically, running in all weather conditions, free-diving and so on.  

What are some of your daily responsibilities?

As a Claims Fraud Manager, I’m privileged to lead a team of 11 Fraud Investigators in a Special Investigation Unit (SIU) of Allianz Suisse. One of my key responsibilities in the morning is the triage of potentially fraudulent claims to my team for an in-depth investigation. In our GAFS we receive daily alerts of potentially fraudulent claims. During triage we decide, on average, in about one minute if an in-depth investigation could be successful or not. One of the tools we use for that decision is Quantexa, which allows us to compare numerous variables of a claim. 

Besides the triage I usually have various meetings with my team and other stakeholders to discuss specific claims:  

• Do we deny or pay a claim?  
• Do we take the claim to court?  
• Why does the customer or his/her insurance advisor want a call from me?  

Separately, we regularly have high-level meetings to discuss the improvement of workflows, GAFS, KPIs, etc. 

How would you describe a typical day as a Quantexa user? 

I normally use Quantexa to triage claims or to answer specific questions. For example, we look at phone numbers, e-mail addresses or bank account numbers (IBAN) to check if a person has more than one identity registered in our system.

"By leveraging Quantexa’s Entity Resolution capabilities, we’re able to find deliberate misrepresentations of identity that we would be unable to spot otherwise or it would take substantial time and manual effort." 

What do you enjoy most in your role? 

My days and weeks are very varied. Sometimes I’m in the role of an attorney, answering legal questions to my team. Sometimes I’m an investigator, trying to solve claims or to create new business rules for our GAFS. Other times I’m purely a manager, who tries to push and motivate my team to achieve our goals. 

What are your main goals as a Fraud Manager? 

Special Investigation Units are usually measured by their savings and only by their savings. Sometimes the goal varies for different lines of business and the number of claims investigated. This is no different in our SIU, however, my personal goal is that my team reaches our ambitious goals in a pleasant and enriching working atmosphere. Denying claims on a regular basis can be mentally challenging as often this leads to friction with the customer. Because of that, it’s very important to have a great team spirit, strong work ethic and fulfilling work in general. I want my team to achieve the goals as a team and not as individuals. Therefore, the team members don’t have individual saving goals or a certain number of claims they must investigate. 

What aspects of working with Quantexa have you found most valuable in enhancing your analytical capabilities?

Building a query in Claims Explorer is quick and easy. Before we integrate a new business rule into our overnight batch screening system, we test the rule in Claims Explorer. This gives us a good indication as to whether or not the chosen variables and their combination provide interesting results. If not, we’re able to quickly modify any variables and test again until we’re happy with the results. From there, we take our learnings into business rule creation in our GAFS.  

In addition to helping us create business rules based on characteristics found in claim documents, Claims Explorer also enables us to run top-down risk analysis on large datasets of claims. This allows us to quickly test different hypotheses of potential organised crime risks or collusive claim behaviours between one or multiple entities in a network which we can later investigate using the platform’s network investigation tools. By looking at risks at a claim level as well as at a network level, we strengthen both our tactical and our strategic fraud fighting pillars of our GAFS. 

How Quantexa has helped you save time in your day-to-day work? 

"Although currently Quantexa is set up to show the same data that we have in our claims system, Quantexa allows the use of filters to analyse and display the data in more relevant ways and on a graphic level. This helps tremendously to analyse large datasets in a short time period. Thanks to these efficiency gains, risks can be addressed faster." 

Could you please share how Quantexa helps you more easily collaborate with third parties like local authorities? 

Due to legal aspects, the collaboration with authorities is very limited. Nevertheless, if we receive data requests from authorities, it was usually a very manual process to filter out the data. With Quantexa, we can enhance this process as we can quickly run a search or query to, for example, find all claims associated with a certain IBAN or person.  

What is your favourite thing about the Quantexa Community?  

The Quantexa Community allows us to dive deeper into certain functionalities of the tool. Furthermore, we gain new perspectives on how others use the tool and its functionalities. 

What is the best tip you have learnt for using Quantexa? 

Have someone in your team who is a Quantexa Super User, who understands the mechanics on a deeper level. So, if you need special advice from time to time, you always have someone in your team to reach out to and lead you back on track. And one thing is for sure, the more you use it, the better you get at it! 

The views and opinions expressed in this communication are those of the individual and do not necessarily represent the official policy or position of Allianz Suisse.