AI Powered Fraud Detection
Use AI powered fraud detection at claims to make an accurate estimation of the risks related to a claim. Automatically detect insurance fraud before claims are paid. Reduce your loss ratio by increasing the chances of fraud detection at claims and limit false positives to a minimum. The solution uses an intelligent detection engine which raises automatic red flags, enables fast track claims and enhances customer experience.
Reduce Insurance Fraud
Insurance fraud is a serious issue for the entire insurance industry. Payment of fraudulent claims has a negative effect on the loss ratio and on insurance premiums. It results into a competitive disadvantage. Moreover, investigating ‘false positives’ takes a huge amount of time and unnecessary costs. Fraudsters are getting smarter in their attempts to evade the insurer’s radar. As a consequence, money flows to the wrong people and thus combined ratios are under pressure. Fraud Detection at Claims helps you to solve these challenges and to reduce insurance fraud.
Fraud Detection Solution
Intelligent Detection Engine
The robust intelligent detection engine uses multiple techniques. Techniques like automated business rules, text mining, image screening, device identification, fuzzy matching, geo-mapping, social network analysis and cross border searches deliver immediate actionable insights. By leveraging historical claims data the engine reveals previously unknown schemes. Implement self-learning models to predict fraudulent claims. Predictive analytics suggest next-best-actions to support claim adjusters and special investigators in their investigation in the fully integrated case management module.
Automated Fraud Detection
Detect insurance fraud before claims are paid. Catch more fraudsters. Use automated fraud detection during the claim process to make an objective and uniform estimation of the risks related to a claim. Receive automated red flags for suspicious claims. Uncover hidden relationships. Claims that need further attention or require active follow-up can be immediately investigated.
Explainable Artificial Intelligence
The AI powered fraud analytics translates into easily interpretable information (XAI), which is visualized into interactive apps. Social networks can be visualized. Fully automate your link detection to identify anomalies. Fight fraud by using AI and get immediate actionable insights in results. The whitebox approach provides a holistic view on suspicious claims. Turn your data into knowledge.
Expert Industry Knowledge Inside
Fraud Detection at Claims is stuffed with over 10 years of industry experience. The ready-to-use and flexible business solution combines analytics, AI and machine learning techniques with knowledge from 150+ implementations at insurers around the world. Expert knowledge is combined with machine learning techniques to enable a guided self-learning solution. You can leverage the FRISS industry experts to maintain the solution or do it yourself. Fraud Detection at Claims is live within 6 months and has an ROI within 12 months.
Integrated Fraud Case Management
Become more effective at fraud investigation by working and sharing cases at one place with all related information available. The follow-up and investigation of possible fraud cases is also supported through an integrated case management module. Moreover, FRISS supports the sharing of fraud incidents and claim history to prevent fraudsters moving around the industry.
Improve Customer Experience
Reduce the number of false positives and improve the customer experience. Because claims can be adjusted faster, the customer has a smooth experience from filing the claim to payout. The screening of a claim can have various touch points in certain stages of the claim process. Because of the real-time screenings this goes fast and efficient. Guiding the sincere customer through a happy customer journey.
As a proven standard, the FRISS Score is the core of the solutions and indicates the risk for each policy application or claim. It provides a white box, holistic view on fraud and risks, delivering actionable insights. The FRISS Score is based on a hybrid detection method. It combines insurance expert business knowledge, out of 10+ years of experience, with external data sources and AI.
The detection system provides an accurate estimation of the fraud and risks with the aid of expert rules, profiles, predictive models, text mining and link analysis together with all available information in more than 100 external data sources. Based on this estimation, a risk score is given (FRISS Score). The higher the score, the higher the potential risk of fraud.