One system for exposing fraudulent claims is based on conversation management, but few people understand the underlying principles. Will Gaskell explains

To download the Power Point presentation for this article please click here (735k)Many of those involved with insurance claims now have at least some understanding of what conversation management is about. But there is still a great deal of confusion as to the exact nature of the principles and techniques underpinning the process.VFM's conversation management product, New ERA, is being deployed by a number of VFM-trained insurers, but ignorance, misunderstanding and misguided amateurism is in danger of bringing the process into disrepute.Let us first agree what New ERA conversation management is not. New ERA is not cognitive interviewing. Cognitive interviewing is a police interview technique used for interviewing witnesses and victims that have an experience to recall. It is designed to help those that have had an experience, often one they want to forget, to remember detail of the event in order to progress a criminal investigation.New ERA is not a technique that can be taught on a training course after which students are left to their own devices. It is a skill that may take up to six months for a novice to become fully independent. And, because it is a skill, refresher training, coaching, and effective supervision are essential to maintaining performance and quality standards. New ERA is not a script. Students are encouraged to think for themselves. In this way they are empowered to ask only relevant questions, in the most effective way, and then make appropriate decision based upon the evidence gleaned.New ERA is not necessarily ideal for screening all insurance claims. Although considerable savings can be made in this way, it is most cost effective when screening claims that have already been filtered in some way, and already identified as ‘high-risk' claims.The skill is not only suitable for telephone interviews. It can also be successfully deployed in face-to-face interviews, for example by loss adjusters and investigators. And there is little doubt that most loss adjusters and investigators currently deployed on insurance claims enquiries would benefit from acquiring these skills, especially when it comes to being customer focused.New ERA is not just for detecting fraud and anomaly in a claimant's story. Its techniques and structure will add massive value to any information collection process. It can be particularly useful as a tool for gathering detail to assess liability in accident claims, assisting with early, accurate and cost reducing decisions.New ERA is not just another ‘hurdle' for the claimant to overcome. It is based upon the following rationale:

  • Most genuine claimants can and will provide details about something that has happened, whereas the fraudster will have real difficulty
  • Concentrating on the claim first, rather than the claimant, or claims history, produces more evidence to justify rejecting a false claim
  • Most claims fraud is committed by people who, for the most part, do not perceive themselves to be criminals. Such people will not feel comfortable expanding upon the lies they are telling
  • Engaging with the customer on the telephone is far more customer focused, personal and productive than entering into prolonged and protracted correspondence
  • Customer care and fraud identification are not mutually exclusive, when the conversations are structured and managed.
  • Therefore New ERA will:

  • Rapidly differentiate between genuine and potentially fraudulent claims over the telephone
  • Improve the way that all claims are managed
  • Massively increase the identification and repudiation of fraudulent and exaggerated claims
  • Significantly reduce the need for fieldwork and site visits
  • Provide ‘escape routes' for ‘inappropriate' claimants to withdraw with good grace
  • Will Gaskell is marketing director VFM