Fraud Detection Analytics

Business Need

Insurance companies lose millions of dollars every year due to claims fraud. The claims investigation process is time-consuming and labor intensive. Claims Adjustors are overwhelmed with the number of claims they handle at once. Claims notes being extremely detailed and verbose, certain important clues and red-flags that are indicators of fraud are inadvertently missed. Minimizing the impact of fraudulent claims has a direct impact on the bottom-line and indirectly benefits other policy holders.

Solution

• Extraction utility from all ODBC compliant databases supported by claims systems
• Starter Concept Bank specific to Fraud Detection and Subrogation Analysis
• Built-in analysis tools and reports including standard formats for export

Benefits

• Increased productivity of the adjustor and SIU teams by minimizing the amount of time spent reading through claim details to pull together facts for analysis
• Reduced cycle time in identifying and enabling timely corrective action on fraudulent claims – early referrals to the SIU increases the likelihood of fraud detection
• Increased flexibility in monitoring fraud profiles based on changing conditions
• mproved effectiveness in reducing incidence of fraud and enhanced loss control through higher rates of SIU utilization (Assists and Consults)