A Powerful Approach to Fighting Claims Fraud
The Insurance fraud problem is estimated to exceed 40 billion dollars globally and is showing no signs of abatement. Insurers, already impacted from a difficult economy, are searching for every opportunity to enhance efficiencies and improve the bottom line.
In the past, that meant adding more investigatory staff to handle new fraud levels. However, given rate of fraud increase, that is no longer a viable option with constrained operating budgets. Further, adding more personnel doesn't solve the problem of uncovering new fraud and prioritizing efforts for greatest impact.
The FICO Claims Fraud Solution provides insurers with a powerful option in the war on claims fraud. With an integrated set of sophisticated components, the solution detects and prioritizes fraud incidents so that most clients experience payback on the solution in a matter of months, not years. The solution consists of:
- Industry leading Analytics, designed to find unknown fraud, with a continuous feedback loop that improve the fraud detection capabilities over time. This component helps prioritize claims by ranking them by likelihood of fraud and providing a reason code to assists staff investigators.
- A solid Business Rules Management System with an easy to use business interface that can stop known fraud schemes early in the process for greater efficiencies.
- A comprehensive Link Analysis capability, designed to efficiently ferret out related fraudulent claims from seemingly unrelated instances.
- The ability to integrate with a client's Case Management System, or leverage a FICO provided, integrated offering for this purpose.
With the FICO Claims Fraud Solution, Insurers will find up to 50% more fraud over rules based systems alone and will realize immediate and significant benefits:
- Detect more fraud - using predictive analytics, known to find more fraud then by simple rules based processes.
- Prioritize claims - with scores that rank by likelihood of fraud, with reason codes.
- Reduce false positives - by leveraging analytics for more accurate fraud identification.
- Stop fraud rings – with link analysis that exposes more fraud from a single related item.
- Improve customer satisfaction – by streamlining the payment of legitimate claims.
- Gain financial benefits – by stopping fraud, pre-payment, with significant bottom line impact.