Bucket vs. Searchlight–a Scientific Approach to Investigating Exceptional & Suspicious Claims (IIMB)
CIP Society Webinar
Date and Time: August 02, 2023 11:00am - 1:15 pm CDT
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As part of an overall strategy response for cost containment, insurance systems often apply some form of a procedural If/Then claim triage algorithm. These types
of If/Then decision models are akin to what is known in systems theory as a Forward Chaining inference engine. These models can rely on the assumption of a stochastic environment. In probability theory, a purely stochastic system is one whose state is non-deterministic (or "random") so that
the subsequent state of the system can be determined probabilistically.
In contrast, a deterministic state
is one where the same inputs can yield different outcomes, and is the world
where we often find ourselves when investigating exceptional (high-severity) and
suspicious (potentially fraudulent) claims, the 'Black Swans' of the
insurance world. Forward Chaining starts with the available data and moves
forward using inference rules to extract more data or obtain more information
until a goal is reached and can be metaphorically visualized as a Bucket.
Complex investigations applying this type of rule system can lead to the ratio
of false-positive or irrelevant data (noise) overwhelming useful information
(signal), decision petrifaction, and seemingly costly and interminable
In response to the challenges
presented by suspicious and exceptional claims, insurance systems can
potentially consider the use of Backward Chaining methodology, which employs a
Then/If strategy for knowledge discovery, by moving backward from a goal. This
approach can also be is described as the Searchlight approach.
This webinar will be in-depth and delivered with
•Learn to apply deductive reasoning and Backward Chaining techniques to the investigation of exceptional [suspicious and high-severity] claims.
• Explore real-world examples on the effectiveness of these techniques effectiveness at in detecting fraudulent claims.
• Understand the limitations of inductive and data-driven fraud detection tools.
Senior Investigator - Xpera Risk Mitigation & Investigation
Brad Nickerson is an accomplished risk management and insurance professional with extensive experience managing cases through the litigation cycle, from inception to trial and post-disposition. For nearly three decades he has been leading investigations, analyzing forensic evidence for its probative value, and constructing systems and methodologies based on his insights.
His work has led to a number of landmark legal decisions in Canada, as well as to a several corporate level loss-control initiatives. Brad holds a BBA from Simon Fraser University, the Canadian Risk Manager designation (CRM), and Certified Fraud Examiner (CFE).
He has been actively involved in several community and professional organizations, including the Burnaby Youth Soccer Association, the Burnaby Lacrosse Association, the BC Soccer Development Program, and the BC Risk & Insurance Management Association (BCRIMA).
Extensive personality testing had identified Brad as a Sigma male (although he doesn’t trust psychologists), and his pronouns are he/him and gone surfing.
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Institute). Please email firstname.lastname@example.org or call 204-956-1702 to
registerNumber of Continuing Education Credits: 2 CE Credits (#42013)
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Tuesday, August 1,
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