Vzpostavitev informacijskega sistema za obvladovanje oseb s povečanim tveganjem v zavarovalnici

BORŠTNAR, JAKA (author), Mahnič, Viljan (mentor)

Obvladovanje tveganj, ki so povezana s strankami zavarovalnic, je za zavarovalnice velik izziv, saj lahko z obvladovanjem le-teh preprečijo negativne posledice. Zavarovalnice se globalno soočajo z zavarovalniškimi goljufijami, ki so eno izmed večjih tveganj zavarovalniške dejavnosti. Različni viri navajajo, da je v Evropi približno 10 odstotkov vseh izplačanih škodnih zahtevkov posledica goljufije. Organizacija ACFE v svoji študiji ocenjuje, da znesek, ki ga zavarovalnice izplačajo goljufom, znaša 5 odstotkov vseh prihodkov zavarovalnic. Večina odkritih goljufij je vezana na dolgotrajne pravne postopke, zato je ključno, da zavarovalnica vzpostavi učinkovit sistem za preprečevanje goljufij in ga nadgradi s sistemom za obvladovanje oseb s povečanim tveganjem, ki obsega vsa tveganja strank, ki so shranjena v vzorcih in pravilih in se uporabljajo za potrebe preprečevanja. V magistrskem delu je razvit informacijski sistem za obvladovanje oseb s povečanim tveganjem, ki vsebuje po vsebini različne sezname oseb. Kriteriji za uvrstitev na sezname so določeni na podlagi preteklih izkušenj zavarovalnice in ekspertnega sistema za odkrivanje in raziskovanje prevar. Za vzpostavitev informacijskega sistema je bilo potrebno razviti podatkovni model, obdelave za avtomatsko umeščanje oseb na sezname, aplikacijo za urejanje, izbris in vnos seznamov in oseb ter vzpostaviti prikaz indikatorjev v vseh ključnih aplikacijah zavarovalnice z navodilom postopanja uporabnika aplikacije v različnih procesih obravnave stranke. Sistem obsega sezname oseb, ki so v preteklosti izvedle goljufijo, bile v sodnem postopku, so plačilno nesposobne, neplačnike zavarovalne premije, regresne zavezance, imajo slab škodni rezultat, imajo slab zavarovalno tehnični rezultat in so tvegane z vidika velike škodne pogostosti. Finančni učinki razvoja informacijskega sistema se bodo pokazali na dolgi rok, saj je zavarovalništvo dejavnost, pri kateri imata zavarovalnica in stranka malo stikov, merjenje učinkov razvitega informacijskega sistem pa je možno le pri sklepanju zavarovanj in pri obračunu škodnega zahtevka. Vzpostavljeni sistem za obvladovanje oseb s povečanim tveganjem je infrastruktura oziroma ogrodje za nadaljnji razvoj in priložnost za nadaljnje delo vezano na vključitev življenjskih, pokojninskih in zdravstvenih zavarovanj in morebitne dopolnitve seznamov še z osebami, ki zavarovalnici prinašajo nadpovprečni donos oz. pomembnih strank zavarovalnice, saj infrastruktura to omogoča.

• Language: Slovenian
• Keywords: informacijski sistem, indikatorji povečanega tveganja, zavarovalništvo, obvladovanje goljufij, obvladovanje oseb s povečanim tveganjem, klasifikacija oseb povečanega tveganja, računalništvo.
• Work type: Master's thesis
• Organization: FRI - Faculty of Computer and Information Science
• Year: 2016
• PID: 20.500.12556/RUL-84839
• Publication date in RUL: 06.09.2016

Secondary language

• Language: English
• Title: Implementation of an information system for managing risky persons in an insurance company

Abstract

Risk management that is connected with the customers of the insurance companies is a great challenge for the insurance companies, for they can prevent negative consequences by managing the latter. Globally, the insurance companies are confronted by insurance frauds which are one of the biggest risks of the insurance industry. Different sources state that approximately 10 percent of all the paid out claims is a consequence of the fraud. ACFE organization estimates in its study that the amount paid to the swindlers amounts to the 5 percent of all the income of the insurance companies. Most of the discovered frauds is connected with a long-term legal procedures; therefore, it is essential that an insurance company establishes an efficient system in order to prevent the frauds and upgrades it with the system of managing the risky persons, which includes all the risks of the clients that are stored in patterns and rules and are used for the needs of preventing. In the master’s thesis, an information system for managing risky persons, which includes the lists of persons different in contents, is developed. The criteria for placing on the lists are determined on the basis of past experiences of the insurance company and expert system for the detection and researching the frauds. In order to establish the information system, a data model, processing for the automatic placing of the persons on the lists, application for editing, erasure and entry of the lists and persons, had to be developed. In order to establish the information system the display of indicators in all the key applications of the insurance company with the manual of user’s managing of the application in different processes of handling the clients had to be established. The system includes the lists of persons who performed an insurance fraud in the past, were a part of judicial proceeding, were insolvent, were defaulted obligors of the insurance premium, persons liable to recourse, have bad damage results, have bad insurance-technical result and are risky from the perspective of large damage frequency. Financial effects of the development of the information system will appear in a long-term period, for the insurance business is an industry where an insurance company and a client have little contacts; measuring the effects of the developed information system is possible only at concluding insurance contracts and in settlements of the claims. An established system for managing the risky persons is an infrastructure or the framework for further development and the opportunity for further work connected with the inclusion of life, pension and medical insurances as well as possible completion of the lists also with the persons that bring above the average yield, or important clients of the company, for the infrastructure enables all that.

• Keywords: information system, indicators of the increased risk, insurance business, fraud management, managing risky persons, classification of the risky persons, computer science.