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Anti-Fraud Claims Solutions

Get equipped to fight claims fraud

Rising fraud, mounting costs

Claims fraud isn’t new for property/casualty insurers, but the game has changed. Digital processes are speeding claim settlements but increasing fraud exposure. And, as claim frequency and costs rise, so does fraud leakage.

Insurers struggle to keep pace

Lack of IT resources, long development processes, and insufficient data make building effective fraud analytics difficult. Meanwhile, SIUs struggle to get meaningful insights to guide investigations.

10 percent of claims are fraudulent. Ready to stop the leakage?

Robust data fuels powerful fraud analytics

Unmatched industry data and leading analytics are the core of Verisk’s comprehensive suite of anti-fraud solutions. It’s why we’re uniquely equipped to empower SIU to fight claims fraud with greater speed, precision, and efficiency.

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Uncover medical provider fraud early

Provider Fraud

Uncover medical provider fraud early

Medical billing data is complex. That’s why it’s the perfect place for unscrupulous providers to hide fraud, waste, and abuse. Our provider fraud solution uses predictive analytics and expert clinical analysis to identify fraud in your medical billing data.

  • Get weekly risk scores for over 1.5 million medical providers
  • Improve investigations with detailed reason codes
  • Lower allocated loss adjustment expenses (ALAE)
Predictive Mini Models

Enhance your analytics with AI powered models

Want better results from your fraud analytics? Boost your organization’s models with out of-the-box, predictive mini-models developed from the industry’s most comprehensive loss history database.

  • Realize a 3X ROI lift
  • Implement mini-models in less than a day
Learn more about predictive modelling
Claimdirector

Detect claims fraud with the power of predictive analytics

Automated fraud analysis at FNOL not only identifies questionable claims early—it also helps expedite legitimate losses. Leveraging machine learning predictive models and 1.5 billion claim records, ClaimDirector accurately scores all incoming claims and provides reason codes to enhance investigations.

  • Improve triage and get actionable insights for investigators.
  • Operationalize the solution in less than a week with no IT lift.
  • Leverage third-party data sets and criminal and civil records.
Learn more about claims fraud analytics

Get the latest anti-fraud insights

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Make your suspected fraud referrals stand out to law enforcement

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Navigating Florida’s complex market with extensive, current roof data

Homeowners insurers and their customers in Florida are navigating a turbulent market, and roof coverage figures prominently in the turmoil.

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Why data is the key differentiator in fraud detection

Organizations have been investing heavily in AI recently, and the insurance industry is no different.

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Is your organization vulnerable to emerging provider fraud trends?

The concept of new and emerging provider fraud trends doesn’t only apply to recent medical providers showing up on your radar.

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Case Management

Streamline case management with automation

Manage all investigative, intelligence, and regulatory functions from end to end with our fully configurable case management platform. The innovative solution helps SIU increase productivity and efficiency by using AI to automate routine tasks such as intake and triage, tracking, auditing, and compliance.

  • Seamlessly integrates with any claim management system
  • Get real-time visibility into cases and investigator performance
  • Shorten cycle times and simplify case management
Learn more about case management
Organized Fraud

Discover organized fraud activity in your claims

Sometimes a simple claim can be part of a larger fraud scheme. Our network analysis software helps you uncover hidden connections among claimants, providers, and businesses by analyzing 1.5 billion claims, plus vetted third-party data.

  • Identify intricate patterns of organized fraud in your claims
  • Save SIU analysts time with automated data link analysis
  • Get customized weekly reports of suspicious networks
Learn more about network analytics

Contact Us to Learn More

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  • Main Toll-Free: 1-800-888-4476

  • Global Toll-Free: International Access code, then 800 48977489
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