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Our Approach to insurance fraud
For many insurers, fraud investigations are handled in a reactive manner, and the only proactive initiative is dependent on the experience or intuition of the person processing the claim. Trends and patterns aren’t obvious, and dormant exposures aren’t visible. Proactively uncovering fraudulent claims requires extensive data gathering and analysis, but such information is often difficult and time-consuming to obtain. SAS approaches the problem by delivering software and services to help you:
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Enhance information credibility by integrating disparate data sources – including third-party sources – regardless of format and applying embedded data quality techniques to ensure accuracy.
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Find fraud before claims are paid using a hybrid of business rules, predictive analytics and social network analysis techniques to uncover hidden relationships, detect subtle patterns of behavior, prioritize suspicious cases and predict future risks.
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Reduce false positives with an advanced scoring engine that uses independent and combined scores, including scoring of associated networks.
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Improve investigator efficiency with advanced case management tools and an intuitive interface that lets them produce complete dossiers of networks surrounding a case, visualize data from multiple angles, perform interactive queries and generate meaningful reports.
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Measure program performance by defining and monitoring key performance metricsnvia a dashboard environment to determine how effective and efficient your programs are at deterring fraud and improper payments.
SAS delivers a complete solution for claims fraud management, enabling you to detect and prevent both opportunistic and professional fraud across multiple lines of business.
THE SAS® DIFFERENCE: Better, faster fraud detection, fewer false positives
Recognized as the industry leader in analytics and with more than 30 years of experience
in insurance, SAS delivers a proven foundation along with best practices that tie
together all the essential areas of claims fraud detection and prevention. The industryleading
SAS Fraud Framework gives you the ability to develop a cohesive strategy for
managing claims fraud with comprehensive:
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Detection and alert generation that enable real-time detection of suspicious activity using a combination of analytic techniques to determine the likelihood of claims fraud.
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Alert management capabilities that let you assemble alerts from multiple monitoring systems to enable investigators to prioritize and triage suspicious claims.
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Social network analysis for going beyond individual views to analyze all related activities and relationships at a network dimension.
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Case management capabilities that provide a systematic means for capturing and displaying all information relevant to an investigation.
No other solution available provides the same level of detection, automation and
power that you get with SAS.
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