Ineffiziente Betrugsermittlung verursacht Überlastung und Bearbeitungsstaus

Definition

The Insurance Council of Australia, together with EXL and Shift, is building a national fraud detection and investigations platform intended to generate **real-time alerts** and enable **collaborative investigations** across insurers, explicitly to detect fraud faster and prevent claims being paid to persistent fraudsters.[2][3] This initiative exists because current investigation processes are slow, fragmented and heavily manual, requiring investigators to sift through large claim volumes and disparate data sources. Advisory firms describe how AI and advanced analytics significantly speed up fraud detection and improve accuracy, indicating that existing manual processes are comparatively inefficient and prone to both false negatives and false positives.[5][8] From a forensic perspective, this manifests as a capacity loss: highly skilled investigators spend hours on data collection, cross‑carrier checks and basic pattern analysis that could be largely automated. Assuming a typical SIU or complex claims investigator spends 30–50% of their week on low‑value manual checks and documentation across 40 hours, this equates to roughly 12–20 hours per FTE per week in preventable effort, or 600–1,000 hours per investigator per year. For a team of 20 investigators at an average fully loaded cost of AUD 150 per hour, this implies avoidable labour costs of around AUD 1.8–3.0 million annually.

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Claims Adjusting, Actuarial Services.

Affected Stakeholders

Leiter Schadenregulierung, Head of Special Investigations Unit (SIU), Claims Investigators, Fraud Analysts, Chief Operating Officer (COO), Chief Claims Officer

Related Business Risks