FICO® Insurance Fraud Manager, Auto Edition

Key Benefits

• Increase claims responsiveness while limiting losses up front
  Advanced predictive models detect claim abnormalities, including subtle signs indicative of fraud, that other types of detection, based on rules, queries and less sophisticated analytics, miss. Detect more fraud before cutting checks, and pay claims with confidence.
• Improve fraud detection consistency and reliability
  All claims receive the same high level of scrutiny, regardless of employee turnover, adjuster caseloads or differences in adjuster experience and skill.
• Catch changing and emerging fraud schemes
  Predictive models detect unusual claims behavior patterns, even when these patterns are changing. They catch abnormalities too complex or new to write rules against. They shine light on systemic issues allowing abusive or fraudulent claims.
• Focus adjusters where they produce the greatest financial impact
  Insurance Fraud Manager scores and ranks claims for likelihood of fraud, enabling adjusters to address the riskiest problems first. Reason codes help them quickly understand what is suspicious about each claim and make the right decision efficiently.
• Lower your total cost of ownership
  Precision scoring, low rate of false positives (legitimate claims scoring high for potential fraud)  and intelligent tools that streamline review and investigation combine to increase productivity and lower costs. Simpler system administration reduces expense—a single model performs more accurate and complex detection than thousands of rules, and without the burden of managing all of them.

Features

• Sees beyond rules to the bigger picture of auto claims fraud
  While rules examine small pieces of data at a time, predictive models analyze hundreds of data points and relationships simultaneously. They analyze each claim in the context of vast amounts of historical claims data—both for that claimant and for claims like the one at hand.  
• Includes Action module to accelerate review
  Guides adjusters to the right next action (adjust claim payment amount, generate notifications and letters, refer claims to investigators) based on the fraud score, reason codes and claim data. Incorporates search, query, sort and data export tools. 
• Includes Investigation module to increase recoveries
  Complete case management includes tools for creating or modifying workflows in both claim-level and broader investigations, and for coordinating and tracking all tasks and activities.
• Provides management controls for more efficient operations
  Supervisors track progress and performance within units or roll it up to “corporate views” encompassing multiple participants and locations. As investigators work, notes and actions are linked with underlying data, so supervisors can readily understand case status and history.

Connect

Speak with a FICO representative about our solutions and your business needs by calling us:

US (toll free): +1 888 342 6336
International: +44 (0) 207 940 8718

Or email us using the form on this page. We look forward to speaking with you.