The reality is different – for now
It all kicks off at the start. Whether it’s a car crash, a TV knocked over by accident or a tree falling on the house: any damage initially causes hassle and stress. But what happens next could hardly be more different. That’s because policyholders now report their claims in many different ways: by phone, by email, by post, via an app or in person at their broker’s office.
Each of these channels triggers a different process at the insurer, often involving separate systems, separate data formats and separate vulnerabilities. Customers are usually largely unaware of this. What happens behind the scenes, however, is a real problem for insurers.
The consequences are well known: data has to be transferred and consolidated manually. Processing times are prolonged by verification procedures and follow-up enquiries. Inconsistent data sets increase the risk of fraud. And staffing costs are rising at a time when skilled workers are already in short supply.
There is another factor to consider: insurance fraud costs the industry billions every year. And the trend is upwards. This is because AI-generated claims profiles and manipulated documents are increasingly pushing traditional, purely manual verification procedures to their limits. The question is therefore no longer whether insurers need to modernise their processes, but how quickly.
The turning point: omnichannel meets fraud intelligence
With artificial intelligence and, for example, Camunda as an orchestration layer, internal processes can be harmonised in such a way that, ultimately, it no longer matters through which channel a claim was reported. This is precisely the basic idea behind modern omnichannel claims management.
For customers, this means, ideally, as little change as possible. They continue to report their claims in the way that is most convenient for them. Behind the scenes, however, a largely automated, intelligent process is at work, standardising claims, classifying them, checking them for plausibility and routing them directly to the correct processing stage.
For insurers, on the other hand, almost everything changes. All claims, regardless of the channel through which they are received, are channelled into the same process. Camunda can manage end-to-end claims processes across multiple core systems, document all steps in an audit-proof manner, and enable both automated processing in standardisable cases and human-in-the-loop models.
Fraud Shield: Two layers of protection, one system
Materna’s Fraud Shield combines two approaches that are often considered separately in practice: fraud detection and fraud prevention – both of which are interlinked and build on one another.
From the insurer’s perspective, fraud detection is the standard entry point for most claims. As soon as a claim is received, the AI analyses all submitted content for anomalies and fraud patterns – including text, voice messages, logs, images and videos. Do the metadata of a photograph match the location and time of the reported claim? Are there any indications of document tampering? Does the nature of the claim match the policyholder’s history? The result of this analysis is a risk score that automatically assesses the likelihood of a fraud attempt. Cases that do not raise any concerns are forwarded directly to the standard claims handling process. Suspicious cases, on the other hand – that is, claims with a high risk score – are automatically flagged, prioritised and handed over to specialist claims handlers. This also applies during periods of high volume, such as following severe weather or the onset of winter.
This is precisely where Fraud Prevention comes into play. It operates downstream of the detection process and is specifically activated when the detection system has calculated a risk score that suggests an attempt at fraud. After all, it is even more effective to prevent fraud from entering the process in the first place than to detect it once it has occurred. Fraud Shield checks in real time whether submitted photos or documents have been tampered with – and intercepts them before the actual claims handling process begins.
More than just fraud prevention: a first step towards modernisation
Fraud Shield can serve as the starting point for a more in-depth IT modernisation. This is because the integration provides, for the first time, a structured overview of the organisation’s own system landscape, which has evolved over the years. Which legacy systems provide relevant data? Which interfaces already exist? Which ones need to be created? Where are the data sets that, although they have existed until now, have been virtually unusable?
Fraud Shield gradually brings clarity to this situation. Legacy systems are not replaced overnight, but are integrated on a needs-based and prioritised basis. Each of these integrations expands the functional scope without jeopardising day-to-day operations. At the same time, it creates transparency regarding data flows, process dependencies and modernisation potential.
In this way, Fraud Shield lays the foundation for a sustainable transformation of the IT landscape. Materna supports this journey as an experienced end-to-end digitalisation partner with extensive integration expertise in complex environments.
Measurable benefits across multiple levels
As part of a modern omnichannel claims management system, Fraud Shield delivers measurable benefits on several levels.
On the cost side, manual verification efforts, fraud losses and processing costs are reduced. On the risk side, systematic fraud detection is improved, even during peak periods and regardless of the input channel. Faster claims processing becomes a tangible service benefit for customers.
Added to this is a practical advantage that many IT managers are likely to appreciate: Fraud Shield is designed to be technology-agnostic and adapts to existing infrastructures. A complex migration process is therefore not strictly necessary. You can get started straight away, with further development taking place step by step. You set the pace.
The best time was yesterday. The second-best is today.
Insurance fraud won’t wait. And the complexity of the incoming channels is not getting any simpler. Those who continue to rely on manual verification processes and separate channel ecosystems will pay the price tomorrow: in the form of undetected fraud cases, unnecessarily long processing times and a growing burden on claims handling staff.
Materna’s Fraud Shield enables insurers to tackle two challenges simultaneously: the harmonisation of their input channels and systematic protection against fraud. Prevention and detection are closely interlinked in this process. And those who make wise use of this starting point will lay the foundations for a gradual, cost-effective modernisation of their own IT landscape.
