SIU Expansion Reaps Company-Wide Benefits

For many years, MetLife Auto & Home’s special investigations unit (SIU) has cultivated a strong reputation as a top-tier fraud-fighting operation. Part of the reason for its success is the company’s vigilance in fraud prevention, particularly using today’s technology.

About seven years ago, then-president of MetLife Auto & Home Bill Mullaney recognized the good work that the SIU was doing and believed the approach could be applied on a broader scale to all of MetLife.

Flash forward seven years later, and MetLife now has one consolidated SIU department, handling fraud operations for most of the company’s U.S. Business operations. Despite the wide variety of products and services offered, the unit retains its focus on the fundamentals of fraud prevention.

In restructuring the SIU to meet the needs of different lines of business, emphasis was placed on transparency. The company developed a strong field operations unit flexible enough to investigate fraud wherever it is suspected, in any type of situation.

To accomplish that, the company cross-trained staff — those who manage investigations from the desk and those in the field — to support one another.

Previously within new lines of business, the majority of investigative work had been accomplished solely at the desk level, with suspected fraud handled in-house using limited resources. That presented challenges, because the fraud department didn’t possess the same scale as its Auto & Home counterpart.

In contrast, the reconfigured model provides all business lines with access to an analyst group, a major case team and the expertise of a trained cadre of field investigators.

A whole array of new possibilities exist, and the head of any department within the U.S. Business group can feel comfortable knowing that his or her people are working with trained specialists who have the resources and capability to investigate any suspicious activity. The bottom line is that by aligning resources, all areas now have a much deeper pool.

As an example in practical terms, say an inside investigator working on a disability claim talks to a claimant, whom he begins to suspect is performing duties inconsistent with the alleged disability. Rather than assigning the matter to a private investigator, the inside investigator now assigns the request to a field investigator for handling. In addition to saving money by keeping the costs in-house, the move places a consistent MetLife “face” on the investigation, instead of an anonymous hired hand.

The united front has been shown to make a world of difference. For example, the company recently had a request from its disability area on a case that took place in Puerto Rico. The company already had an investigator on assignment there for an unrelated case, so it was simple to have the investigator contact the claimant in question and ask to meet with him. Upon making the call, the claimant refused to meet, but mysteriously offered to reimburse any money he may have accepted in error. Shortly after, the claimant withdrew his claim.

From an investigator’s standpoint, the configuration allows MetLife to maximize abilities. Investigators enjoy branching out into different areas, because it provides more variety than handling the usual staged claim or medical mill operations.

From a company perspective, because of their years of experience in the field, investigators are able to leverage connections they’ve made with local law enforcement to aid in investigations in other areas — connections smaller operations would not have access to. Simply put, Auto & Home SIU investigators have opened doors that other lines of businesses are now able to walk through.

Of course, there’s the technological aspect, too. The current configuration allows other MetLife lines of business to take advantage of technological expertise, particularly the ability to data mine.

Previously, other departments lacked the size and scale of their Auto & Home counterparts. Fraud operations within other lines of businesses were not able to embrace technological enhancements with quite the same vigor as Auto & Life had, because it was difficult to justify the expenditure.

There since has been a smoother transition into Auto & Home’s data-driven operating model.

SIU’s technological expertise has benefited, for example, the dental unit, because it’s been able to identify abnormal patterns of practice. Before data mining techniques were employed, MetLife’s dental experts had to take a conservative view regarding some charges that seemed out-of-the-ordinary. Through data mining, it has become infinitely easier to demonstrate that an individual’s pattern of practice does not conform to general dental industry practices. By demonstrating this objectively, it is now far more difficult to be dismissive of these abnormalities, because they no longer can be explained away. Data mining techniques have allowed the unit to take a closer look at the bigger picture and protect the dental benefits of customers.

The SIU also has benefited from the knowledge and expertise of other parts of the MetLife enterprise. This is particularly true in technology. One relationship the unit has cultivated is with MetLife’s quantitative research and modeling (QRM) department.

A few years back, the company discovered that both departments used the same outside vendor for data mining modeling technology. Once this connection was made, David McMichael, assistant vice president within QRM, took a real interest in fraud. The result was a proposal for his department to build the modeling technology it was paying an outside vendor to build. The company now uses a proprietary MetLife solution, which not only has reduced expenses, but it dramatically improved results as well.

The same technology is being used to benefit pricing and risk, too. The technology is not just for SIU anymore, but it plays a larger role in the company.

In order for companies to replicate MetLife’s success, several critical elements needed to be in place.

A company must be willing to break down silos, as well as to step beyond traditional departmental functions.

Of course, the company must possess the size and scope to generate the critical mass necessary to make such an operation feasible.

Finally, support of all layers of the organization is needed — including senior officers, such as the chief claim officer and CEO, as well as investigators who are charged with doing the difficult day-to-day work.

The lessons MetLife learned from its successful auto and home fraud prevention program are ones that other companies can learn. The trick is to achieve the appropriate balance between all of the elements and to allow it to endure for the long-run.

That balancing act is one MetLife believes it has been fortunate enough to maintain for quite some time, and one that will allow the company to be nimble enough to weather whatever the future has in store.