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Scale-up means youngish (10-12years old), mid-size in the countries we are operating, think 3 countries 600-800m revenue. Fraudulent claims are a tiny percenta
by michaeljx 2y ago
Scale-up means youngish (10-12years old), mid-size in the countries we are operating, think 3 countries 600-800m revenue.
Fraudulent claims are a tiny percentage of claims, and are rejected after human review, usually involving detectives. In the countries we operate, fraudulent claims are about 6-8% of all claims, and that's usually the level we aim to detect. Being able to absorb some false negatives is usually cheaper than going for the full 100% detection rate. It is definitely more customer oriented than rejecting due to false positives.
- avalys 2y agoIs this a health insurance company or are you providing property insurance?
- michaeljx 2y agoNo this is general insurance (motor, property, travel etc). It is also founder-led, which is an important factor, as the reason they started it was their personal frustration with the motor insurances.
- nradov 2y agoYour experience in general insurance has nearly zero relevance to US health insurance. Their main customers are large self-funded employers and they operate under a completely different legal regime. Most of their business is no longer even "insurance" in the traditional sense.
- motorest 2y agoOP's point is orthogonal to whatever legal regime is in effect. OP's point was that fraudulent claims are at a residual level. If anything, general insurance is expected to have higher rates of fraudulent claims than health insurance.