FRAUD · TRAVEL INSURER · EUROPE

An organised network hiding in plain sight.

CHALLENGEA high-volume travel book with rising claims leakage, and an investigation team overwhelmed by false positives from a rules-based system.

APPROACHRelationship analysis across claimants, providers and payment details revealed a connected network of claims that were unremarkable one at a time.

OUTCOMEInvestigations refocused on the claims that mattered. Leakage was reduced and, just as importantly, genuine claims were settled faster.

DISTRIBUTION · MGA · EUROPE

The best-selling channel was the least profitable.

CHALLENGECapacity providers were questioning channel mix ahead of renewal, and the MGA had no comparable view of channel profitability.

APPROACHA channel scorecard ranked every route to market on claims-adjusted margin, revealing that the highest-volume channel ran at a loss.

OUTCOMEGrowth was redirected, one loss-making partner was renegotiated, and the renewal conversation shifted from scrutiny to a growth plan.

CLAIMS · MEDICAL ASSISTANCE · MIDDLE EAST

Provider costs no one could compare.

CHALLENGEProvider costs varied widely across regions with no consistent benchmark, and the carrier wanted evidence of cost containment.

APPROACHA provider benchmark normalised for case mix made outliers and strong performers visible on the same scale.

OUTCOMERenegotiation focused on the outliers, and the saving was evidenced to the carrier in terms it recognised.

RENEWAL PRICING · MEDICAL INSURER · MIDDLE EAST

A flat uplift was subsidising the wrong half of the book.

CHALLENGERenewals carried a flat uplift across the book. Loyal, profitable segments were lapsing at the rise; loss-making segments renewed without hesitation.

APPROACHThe renewal book was segmented on its own claims experience and lapse behaviour, and differentiated uplift scenarios were modelled before any notice was issued.

OUTCOMEA differentiated renewal round the pricing committee signed off on evidence. Retention held where it mattered; the segments that had never paid for their risk were corrected or exited.

RESERVING · MEDICAL INSURER · EUROPE

The reserve looked comfortable until the currency moved.

CHALLENGEReserves that looked adequate at each review kept needing year-end corrections, driven by currency movement and late reporting from overseas providers.

APPROACHDevelopment was rebuilt by settlement currency and provider geography, a scenario grid stressed inflation, delay and FX together, and monitoring ran between reviews.

OUTCOMEDivergence was flagged months earlier, a documented range replaced a single point, and year-end stopped being the moment bad news arrived.

EXPERIENCE ANALYSIS · REINSURER

Two cedents, one loss ratio, very different books.

CHALLENGETwo cedents arrived at renewal with near-identical headline loss ratios. The underwriting team suspected they were not equal risks, but could not show why.

APPROACHExperience analysis decomposed each book into frequency, severity, development speed and fraud propensity, benchmarked against comparable portfolios.

OUTCOMETerms were differentiated on evidence, the questions put to each cedent sharpened, and both relationships survived the renewal.

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