Claims Process Automation and Claims Fraud Detection

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With RiskShield, INFORM offers an intelligent tool for risk management, claims process automation, and AML compliance (Customer Due Diligence, Suspicious Activity Monitoring, and Watchlist Screening). Using RiskShield, carriers can manage and mitigate risks due to fraud and suspicious activity as well as automize claims processes. This way, they can reduce enterprise costs, accelerate operational activities, improve workflow efficiencies, and maximize their customer’s satisfaction.

With its continual analysis and rescoring in just milliseconds, RiskShield can monitor from significant to minimal changes in customer behavior across multiple claims, lines of business, and systems that may change due to the slightest changes in the data structure. RiskShield can discover, analyze, visualize, and expose dishonest individuals who are exploiting insurer vulnerabilities.

Key Features

  • Assess the fraud and claims leakage risk of a claim, detect inappropriate behavior, and automize claims processes
  • Use the hybrid artificial intelligence approach, encompassing both knowledge-based and machine learning methods
  • Network detection to track fraud rings
  • Transparency and traceability of decisions support internal audits
  • Real-time and high-performance detection engine supports in-time decision making, routing of claims. and triggering of systems
  • User-friendly and intuitive rule management tables insurance companies to take full responsibility of the solution
  • Decide between on-premise installation or hosted solution

Key Benefits

  • One solution for multiple lines of business
  • Accurate fraud detection supported by powerful case management functionality
  • Real-time decisions streamline claims processes and provide more efficient and cost-effective claims handing, increase productivity
  • Automized decisions when to access external data reducing costs for external service providers
  • AML Compliance (Customer Due Diligence, Suspicious Activity Monitoring, and Watchlist Screening)
  • Leverage from profound experience in fraud-fighting and claims process automation
  • Enhance your customer satisfaction

More than 40 insurance companies worldwide benefit from RiskShield.