ISO ClaimSearch® streamlines suspicious claims reporting

ISO, together with the National Association of Insurance Commissioners (NAIC) and the National Insurance Crime Bureau (NICB), has implemented a new automated workflow to streamline the reporting to state fraud bureaus of possible fraud in filed insurance claims.

Most state insurance regulators mandate that insurance companies report suspected fraudulent or suspicious activities found in insurance claims. Now, when NICB member companies refer a suspicious claim to the NICB through ISO ClaimSearch®, the system sends the report automatically to 47 jurisdictions (45 states, the District of Columbia, and Puerto Rico) through a direct system connection from ISO ClaimSearch to the state or through the NAIC Online Fraud Reporting System (OFRS). Either process eliminates duplication of reporting activity by insurers in those states.

ISO ClaimSearch provides the reporting system that the NICB and its member companies use.

The new reporting process:

• enhances information flow about potential fraud throughout the industry
• protects consumers and insurers
• saves time and money for insurance companies and fraud investigators
• improves investigative resources for state fraud bureaus

The NICB and ISO expect to provide the NAIC OFRS with approximately 80,000 reports of suspected fraud each year. Since implementing the process earlier in 2010, ISO ClaimSearch has already seen an increase in the reporting of potential fraud.

The initiative is part of our continuing effort to streamline the claims and fraud investigations process and assist the industry in its ability to combat fraud.