Insurance fraud is a major challenge faced by insurance companies, costing more than $300B every year. Beyond the financial losses, companies spend significant resources to investigate and verify fraudulent claims.
Anti-Fraud One is a comprehensive solution that helps insurance companies uncover, prevent, and resolve insurance fraud by bringing together the latest technologies in claims and medical fraud.
The most used solution in the P&C industry. One solution. One platform. One user experience.
Anti-Fraud One lets you score and evaluate claims quickly and effectively using your own real-time data and aggregated data from 95% of P&C industry carriers. You can avoid the significant costs and months of IT resources spent on gathering, transforming, and loading historical data sets to an alternate vendor system. Consequently, it’s easy to try Anti-Fraud One and see the results for yourself.
As insurers strive for low-touch and no-touch claim processing, there’s an increasing need for fast and accurate fraud detection to mitigate risk. Anti-Fraud One employs machine learning and predictive models to deliver highly accurate claim scores and actionable reason codes to support faster triage, evaluation, or settlement.
Anti-Fraud One also lets you customize your own rules of interest for your book of business with expert business rules, running in parallel for a seamless and tailored experience.
Medical provider fraud, waste, and abuse (FWA) is a major problem for insurers. The main challenges for carriers are identifying which providers are billing for suspicious treatment and identifying the outlier trends and anomalies billed for.
Anti-Fraud One harnesses aggregated industry data and advanced analytics to help you quickly and easily discover medical provider fraud, waste, and abuse schemes in your book of business.
Anti-Fraud One provides valuable insights for insurers, including:
Anti-Fraud One offers an industry-wide view of a provider’s treatment. Scoring, the reason for the scoring, and peer benchmarking provide intelligence beyond a provider’s activity in your own records. Analyzing data from the NICB’s Aggregated Medical Database—the world’s largest P&C billing data repository—Anti-Fraud One helps you identify suspicious providers and questionable treatment using advanced analytics.
With well over 100 advanced analytic models for detecting fraud, waste, and abuse, Anti-Fraud One enables you to quickly analyze provider treatment, as well as spot new and lesser-known exposures, high-risk situations, and emerging trends.
Anti-Fraud One quickly delivers lift and efficiency to your SIU and casualty operations by providing:
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