Increased quality of insurance fraud investigation
Investigation of insurance fraud is a complex process, and the volume of cases is ever increasing. Good support from a case management system is therefore essential to ensure high-quality investigations.
In early 2021, Tryg launched a new case management system for investigating insurance fraud. Using low-code software, Tryg developed their solution in collaboration with KPMG Lighthouse and Genus Professional Services.
Tryg is the second-largest insurance provider in the Nordics for general insurance. They provide protection for more than two million private individuals and employ 4000 people.
Tryg had a total income of DKK 22 billion in 2019, and total equity of DKK 12 billion.
A safe bet for investigation case management
Insurance companies in the Nordics suffer billions of DKK in losses each year from payouts in fraudulent insurance claims. To combat this, Tryg employs a unit with investigators targeting false claims. The main goal of this unit is to uncover crimes and avoid illegitimate payouts.
However, investigating false claims is a complex process, often involving multiple investigators, lawyers, and claim handlers over several years. Therefore, Tryg needed a system that aided them in organizing and documenting the investigation of the persons, organizations, and assets involved.
Their existing case management solution had few integrations and the information needed for the investigation was distributed on several systems. Also, the old case management system was not adapted to their current work processes. Thus, Tryg chose to explore the possibility to develop a new case management system and settled on using Genus as the technological platform.
“Genus had a good record of accomplishment on delivering case management solutions to fraud investigators. Additionally, most of our investigators have experience with case management solutions based on Genus from former employees in the public safety sector. Genus was considered as the ‘safe bet’” – Tormod Seljenes, Project Manager at Tryg
The new solution, named Sicam, enables Tryg to keep all relevant information in a single case management system. It provides process support, document handling, reporting, improved data quality, and a data retention policy.
The solution receives cases from new and several legacy claim systems through integrations and automatically collects and presents relevant information such as:
- Documents and files
- Involved parties
- Contact information on involved parties
- Previous claim history and other fraud investigations of the involved parties
Since Tryg operates in multiple countries, the solution needs to handle sensitive and personal data from customers in multiple countries. Thus, to ensure compliance with laws and regulations for each country, Tryg decided to store the data of the solution in country-specific databases. The Data Set-feature of Genus easily enables this kind of separation, while the application itself is shared across countries.
The implementation team
Sicam was implemented by a team consisting of Tryg’s own experts, who contributed with subject matter guidance, and experts on the Genus platform from KPMG Lighthouse and Genus Professional Services.
KPMG Lighthouse is a department of KPMG with technical experts developing innovative digital solutions to solve business challenges.
“The Genus platform is a great tool for rapidly developing new applications. The platform is fast and easy to use, and the development process is intuitive using visual modeling tools. The solution is easily implemented using the drag and drop functionality of prebuilt function block components to develop the desired solution. Integrations with 3rd party systems are effortlessly achieved by using the built-in functionality in the platform. Deploying changes to the application is extremely fast, simply by the click of a button. This allows for continuous user testing as changes are available at once, which adhere to the continuous delivery approach in the DevOps practice.“– Eric Olsvik, Digital Process Automation and Low-code developer at KPMG.
Seeing the success of the project and the potential the Genus platform provides, KPMG is highly motivated to pursue further opportunities with Genus.
“The Genus platform is a secure, fast, and easy to use low-code platform enabling companies such as Tryg to achieve Digital Transformation at a rapid pace. The platform significantly reduces implementation time compared to the more traditional custom coding approach and enables the project and developers to focus on delivering results that matter. The low-code market is growing fast and we believe that low-code platforms such as Genus will be an essential tool for businesses to stay agile, to be able to meet fast-changing user demands and customer expectations and to remain competitive in the future. “– Henrik Hjelseth Hansen, Head of Digital Process Automation and Low-code platforms at KPMG.
KPMG Norway became a partner of Genus in 2019.
Increased quality of investigations
Tryg already observes higher quality on their fraud investigation cases due to the support provided by Sicam. In particular, the document handling, the standardized workflow, and the ability to see all information about the case and the involved parties significantly improve the quality of the investigations.
“We are already observing a higher level of quality in our investigations. We are also looking forward to now being able to continuously adapt and tune the system as our processes evolve.” – Thomas Sørensen, Senior Special Investigator at Tryg.