Claim fraud analytics service

Create a vendor selection project & run comparison reports
Click to express your interest in this report
Indication of coverage against your requirements
A subscription is required to activate this feature. Contact us for more info.
Celent have reviewed this profile and believe it to be accurate.

Overview

Our claims fraud analytics service uses predictive modeling and more than 600 business rules to identify, score, and prioritize possible cases of fraud. It not only reduces insurers' fraudulent claims payouts, but also helps them avoid reputational damage or loss of customers because of premium increases.

Key Features

  • A continuous scoring framework that triggers algorithm scoring starting at first notice of loss (FNOL)
  • Extracting intelligent data (internal and external) to seamlessly connect and aggregate data from multiple disparate data sources and formats
  • Text analytics to build additional indicators from unstructured data such as claim notes and investigation reports
  • Advanced analytics to run all suspicious claims through one or more supervised and/or unsupervised machine learning models
  • Triage analysts to review and analyze the data and refer cases with the highest-risk score to the SIU team

Key Benefits

Boost customer satisfaction, shrink loss adjusting expense, and sharpen loss accuracy with our claims management solutions