By: Claim Analytics  09-12-2011

Claim Analytics, Predictive Modeling, Predictive, Model, predictive model, Insurance, Benchmarking, Scoring, Claims, Data Mining, Patter Detection, Acturial, Actuary, Long Term Disability, disability, claims data model sample, fraud detection, probablility

Greater Reserving Accuracy

Claimant-specific rates

Claimant-specific termination rates deliver appropriate disabled life reserves for each claim. This ends the ‘averages of averages’ problem of traditional methodologies.

Traditional methodologies are constrained by their inability to manage more than a very limited set of claim differentiators: at best age, gender, elim period and one or two others.

The Claim Analytics approach is to apply advanced predictive modeling techniques to determine precise, claimant-specific termination rates. These rates are based on key drivers such as:

  • age
  • gender
  • elimination period
  • primary and secondary diagnoses (not just diagnostic category)
  • occupation
  • industry
  • income
  • benefit level
  • change in definition date
  • geographic region and
  • number of previous claims by the same claimant.

Greater Accuracy

This methodology results in reserves for each claimant that reflect that claimant’s true probability of terminating. Our approach provides:

  • an improved measure of profitability
  • less earnings volatility
  • better information for pricing and experience rating.

Evaluating IF Blocks of DI

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Other products and services from Claim Analytics


claim scoring

Claim scoring uses advanced pattern detection technology to provide a numeric measurement of the likelihood of return to work of a disability claim. This accurate and objective measurement of disability or workers compensation claims enables the optimizing of all claim management resources. Forecasting Return to Work with Predictive Modeling By Barry Senensky and Jonathan Polon.


claim approval

The model was built by quantifying patterns in historical approval decisions and applying this logic to score newly reported claims on the likelihood that they would be approved based on an insurance companies existing practices. A score of 2 will indicate that eligibility and compliance to the duration guidelines need to be checked and then the claim can be approved.


fraud detection

Our technology goes beyond traditional rules-based approaches By comparing each claim to every other claim, and each practitioner to every other practitioner, our technology goes beyond traditional rules-based approaches to fraud detection. The claim history of each provider is compared to every other provider of the same specialty and outlier are quickly and easily identified.



The same pattern-detection tools used by Claim Analytics are the tools of choice for many of the world’s toughest and most complex applications – credit card fraud detection, consumer buying prediction, weather forecasting, and taxpayer profiling. The Claim Analytics pricing approach incorporates claimant-specific reserves for each open claim. Disability Insurance PricingBetter Analysis For Improved Pricing Accuracy.