AI: The good, the bad, and the unknown
Presented by: Jim Leyse, Underwriting Consultant, Sammons Financial Group
Summarized by: Jennifer Johnson, Vice President of Underwriting Solutions, RGA
Key insights
Machine learning and deep learning can be trained to detect anomalies in data that may indicate fraud. AI’s ability to process vast amounts of data and recognize patterns makes it well-suited to detect complex fraud schemes such as rebating, stacking, churning, ghostwriting, and account takeovers. But human intelligence remains essential to interpret these anomalies and validate red flags. Understanding the mindset and tactics of fraudsters is essential. Carriers must continually adapt their defenses by using, yes, AI, but also behavioral science and cross-functional human collaboration.
Top action items
- Educate teams on fraud tactics. Share real-world examples to build awareness and vigilance, and promote a one-step-ahead “chess mindset” that encourages strategic thinking and proactive defense.
- Monitor application submission patterns. Track frequency, timing, and geographic clustering. Use image recognition tools to detect forged or digitally manipulated documents, a critical step in protecting against synthetic identity fraud.
- Industry-wide collaboration is essential. Sharing fraud data across carriers can help AI models learn faster and adapt to emerging threats.
Favorite quote
“Artificial intelligence is just modeled after human intelligence. The machine can learn, think, and reason like a human can — to a degree."
Beyond Protection: Reimagining fraud prevention with protective value insights
Presented by: Trey Reynolds, Executive Vice President, MIB Group; and Jen VanderSteenk, Senior Director of Underwriting, Americo Financial Life and Annuity
Summarized by: Colin DeForge, Vice President of Underwriting, RGA
Key insights
The US life insurance industry paid out $89 billion to beneficiaries in 2023, a total that nearly matches what the US pays in Social Security benefits annually. In doing so, fraud costs each life insurance carrier an average of $300 million each year.
Top action items
Partnering with law enforcement is vital to fight fraud. Merely terminating bad agents or rescinding policies when fraud is discovered allows bad actors to pop up again in a different place to do the same thing again and create more victims. The spill-over effect raises prices for those who are law abiding and honest and reduces access to the financial protection that insurance offers.
Favorite quote
“This is where the noble work really comes in. We talk in our industry about a 40% coverage gap, the percentage of individuals who have either not purchased life insurance or don't have adequate life insurance. I know life insurance is relatively inexpensive, but cost is still the primary reason. It's our responsibility to bring that cost down so that every individual can afford life insurance.”
Why Do We Lie? The psychology of lying and how to use it to promote honest insurance disclosures
Presented by: Rosmery Cruz, Executive Director of Behavioral Science Data, RGA; and Dr. Peter Hovard, Vice President and Chief Behavioral Scientist, RGA
Summarized by: Stuart Lewis, Head of Claims, RGA Asia
Key insights
Rationalization enables dishonesty. When people believe they are entitled to something, they can justify doing something wrong, such as being dishonest on an insurance claim or application. They are then able to do something that they know is wrong without creating any self-harm or guilt. If insurance companies normalize dishonest customer behavior, they assist in creating an environment where people will be dishonest.
Also, fraud risk is not just from those people who set out to be deliberately dishonest. It also comes from otherwise good people who, in certain situations, will choose not to be honest. Insurance companies need to recognize this and be aware that people will not always be honest.
Top action items
When reviewing steps in our processes where we look at automation, recognize that if we can humanize the insurance process, we create an environment where people are more likely to be honest. Look for ways to use messages to promote positive behaviors. For example, focus on the 95% of customers making honest disclosures rather than the 5% who are not.
Favorite Quote
“We don’t have barriers; we have honest customers. This concept has the potential to be applied to how insurance companies approach both application and claim forms. It is a reasonable positive statement that endorses the right behaviors.”
Fighting Fraud: How collaboration is revolutionizing the insurance industry’s ability to combat fraud
Presented by: Richelle Feddema, Senior Manager of Anti-Fraud Member Management, Canadian Life & Health Insurance Association; and Jared Green, Director of P&C Claims, American National
Summarized by: Dr. Liliana Silva Moreno, Senior Medical Analyst, RGA Latin America
Key insights
The threat of benefits fraud and abuse in the Canadian health insurance industry is growing, but collaborative efforts are transforming fraud detection and prevention.
Top action items
Industry-wide initiatives such as data pooling, joint provider fraud investigations, and educational campaigns are key to fighting fraud. These tools enable insurers to identify suspicious patterns, share evidence securely, and take coordinated action against fraudulent providers. Case studies illustrate the effectiveness of these programs, demonstrating significant financial savings and improved fraud mitigation through joint investigations and AI-powered analytics.
Favorite quote
“Benefit fraud threatens the sustainability of our plans, their affordability, and access for the 27 million Canadians who rely on their benefits. It’s not a victimless crime. It affects us all.”
A Journey Through Life Insurance Fraud Case Studies, Current Strategies, and Personal Insights
Presented by: Doug Parrott, Chief Underwriting Officer, Foresters Financial; and Valerie Howes, Chief AML officer, Foresters Financial
Summarized by: Karen Riendeau, Executive Director of Technical Claims, RGA
Key insights
- Early detection is the key.
- Independent agents are more likely to commit fraud than captive agents.
- Simplified issue policies sometimes fly under the radar, and certain issue processes can be overlooked when looking for important elements.
Top action items
- It is important to search data sources on the front end, at the time of application.
- Online portals are the prime target for fraud and need to be monitored closely.
- The digital footprint of someone is more accurate than it has ever been. Use these numerous data elements in place of older, handwritten information.
Favorite quote
“There’s a lot of money at stake, and the fraudsters know this. Now it’s globalized, so it can be committed from virtually anywhere, which can make it hard to detect and prosecute.”
Digital Dilemmas: Balancing AI power with ethical responsibility in fraud prevention
Presented by: Jeff Myers, Vice President of AI Systems, RGA
Summarized by: Tony Michaud, Executive Director of Claims, RGA
Key insights
Generative AI improves data analysis, uncovering complex patterns that allow for better decisions and improved fraud detection. AI can learn from new data over time, but that data still should be checked by humans to guard against AI “hallucinations,” where AI completes gaps with what it thinks should be there but, in truth, is fictional.
Top action items
Incorporate AI into fraud detection, but balance that technological push with the skills of talented humans to verify AI’s output.
Favorite quote
“Machines don’t get bored. They approach situations with the same level of commitment and excitement from the first time to the 1,000th time.”
Nomadic Life Insurance Fraud
Presented by: Rich Law, Complex Case Consultant, Diligence; and Gregg Brown, Assistant District Attorney, Richmond County District Attorney’s Office
Summarized by: Larry Ryan, Vice President of Group Re Operations, RGA
Key insights
- Fraud is organized and sophisticated — Life insurance fraud rings operate like organized crime, using complicit agents, paramedical examiners, and false identities to obtain multiple policies worth millions.
- Systemic gaps enable fraud — The lack of a centralized database, poor information-sharing between insurers, and limited reporting to law enforcement allow fraudsters to exploit loopholes and continue schemes undetected.
- AI could transform detection — Fraud patterns (duplicate phone numbers, identical lab results, unusual payment structures) can be caught earlier with AI, something manual review cannot achieve at scale.
Top action items
- Strengthen information sharing across carriers — Ensure rescinded or flagged policies/agents are shared across insurers to prevent stacking and repeat fraud.
- Leverage AI for fraud detection — Deploy AI to scan applications for anomalies (shared data, unusual premiums, duplicate labs) and assist with subpoena responses.
Favorite quote
“Illusion and confusion. Fraudsters deliberately create illusions — altered digits, false addresses, fake labs — to cause confusion, betting that insurers will give up and pay out."
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