Clark J. Frogley
Executive VP & COO, Chartis Global Investigative Services
Insurance Fraud Analytics – The Data You Cannot Afford To Ignore
Over 160 countries, more than 100 languages, millions of policy holders and hundreds of millions of claims applications constitute the typical data set that AIG deals with on an annual basis. Today, most of that data is reviewed and managed by human beings attempting to provide quick and customer focused response to individuals, small businesses and large corporations in what is often very emotional and difficult situations. Earthquakes, hurricanes, floods, riots, political turmoil, fires and theft all result in someone needing help from their insurance carrier. However, within that data, industry experts and benchmarks indicate somewhere between 1 and 2% of paid losses are fraudulent. Put another way, between 3 and 10% of annual claims submissions are identified as suspicious and require investigation.
Managing data in a vertical environment creates a situation that relies on happenstance and luck to identify much of the potentially suspicious documentation that is the lifeblood of an insurance company. Data analytics, and specifically predictive analytics and link analysis, allows real time three dimensional analysis to determine that 3 policies under different names all come back to the same cell phone number; one person was the witness to 3 automobile accidents in a given month; or a large group of injured workers are all going to the same medical doctor, receiving the same diagnosis, and are represented by the same attorney no matter where they live in the state. For a company like AIG, that means hundreds of millions of dollars are at risk due to potential insurance fraud. Data analytics is being used to lead the way to working more globally, more intelligently and much more efficiently in detecting potential fraud in the insurance business.
Mr. Frogley is responsible for the global strategic development and operational management of the fraud investigative function within Chartis. He has direct responsibility for the investigations and investigative personnel across 160 countries where Chartis does business, focusing on suspicious claims, premium, underwriting and provider fraud.
Prior to joining Chartis in January 2009, Mr. Frogley held the position of Managing Director, Global Head, Fraud Prevention and Investigations, Deutsche Bank, AG. Prior to that, Mr. Frogley held various senior positions within Deutsche Bank and Goldman Sachs to include Managing Director of Corporate Security and Business Continuity for all of Asia and North and South America, and Regional Head of Global Sourcing and Contracts in Asia Pacific. Mr. Frogley also held several senior positions within the FBI to include Assistant Legal Attaché – U.S. Embassy, Tokyo, Japan where he was a diplomatic member of the embassy’s Transnational Crime, Counter Intelligence and Security Teams.
Mr. Frogley is well known for his expertise in Anti-Money Laundering, Anti-Fraud, Business Transformation, Mergers and Acquisitions Due Diligence, Change Management, Corporate Security, Business Continuity, and Operations over the last 25 years and has been a featured speaker at numerous conferences in the US and Asia Pacific.
Mr. Frogley speaks fluent Japanese and holds a Bachelor of Arts in Asian Studies and Japanese from Brigham Young University, and an MBA Summa Cum Laude from Temple University’s Fox School of Business.