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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.

1000 Plus Rules
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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 

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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Uncovering digital media fraud with advanced forensics

Straight-through processing is considered the holy grail of digital claims—where insurers can intake, process, and pay claims automatically

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Why Embracing Ethical AI is Critical for Insurers

As insurers’ interest in artificial intelligence (AI) grows, we must not only embrace its immense capabilities but also work to mitigate its potential risks.

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Is that loss photo legit? Fighting digital image fraud

Photo-based claims estimates have been a growing trend the past few years in the insurance industry, and once the pandemic hit, that trend accelerated significantly.

Read the article 
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Medical-related fraud and theft increase during COVID-19 crisis

Unfortunately, crisis is fertile ground for fraud, whether it be the opportunistic kind or organized criminal activity.

Read the article 
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
    When calling from the UK, please dial 00 800 4897 7489

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