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Anti-Fraud One: The ultimate solution to combat insurance fraud

The premier anti-fraud solution to stay ahead of sophisticated insurance fraud

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

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.  

Insurance automation from policy through claim


Fight claims fraud with predictive analytics

Claim Scoring Icon

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.

Fast and accurate fraud detection

Laptop With Data On Screen

Fast and accurate fraud detection

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.

Identify questionable claims at FNOL

Detect potential fraud early by:

  • Generating scores to accurately prioritize claims for investigation
  • Producing clear, actionable reason codes to guide the investigation
  • Analyzing claims using 1.6 billion records from ClaimSearch
  • Incorporating third-party data and civil/criminal records while identifying financial motive
  • Tuning predictive models to your company’s specific investigation results
  • Providing meaningful context for model output using fraud scenarios for special investigations units

Customize your fraud detection

Build custom fraud scenarios in a sandbox environment to test ideas using expert business rules and other data points to create more efficient and flexible fraud detection.

  • Create a more focused approach to fraud detection
  • Respond quickly to emerging risks
  • Collaborate more effectively with data scientists and analysts to optimize scoring
  • Enhance fraud detection by checking for photo duplication or alteration

Stop medical provider fraud

Medical Provider Scoring Icon

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.

Identify provider fraud early

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:

  • Prioritization of scored providers based on an industry-wide view of their treatment data
  • Reasons for a provider’s treatment scores for setting an investigative action plan
  • Benchmarking provider treatment to their peers within their own specialty
  • Identification of anomalies, outliers, and questionable treatment necessity
  • Focused leads and clues on potential schemes, exposures, trends, and emerging risks
  • Guidance for potential next steps for each triggered reason

Leverage industrywide provider billing data

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Leverage industrywide provider billing data

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.

The aggregated medical database includes…

500kproviders V2

5mpatients V2

$47bbilled Financial Exposure V2

Powerful models deliver results

Women Reviewing Data

Powerful models deliver results

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.

Realize significant ROI

Anti-Fraud One quickly delivers lift and efficiency to your SIU and casualty operations by providing:

  • Enhanced models that can detect more FWA
  • Rapid identification of problem providers and potential non-meritorious claims
  • A focus on the most significant issues, remedies, and exposures
  • Improved referral quality leading to more productive investigations
  • Shorter cycle times with deep intelligence insights

Contact Us to Learn More

Other Ways to Connect

We are available Monday through Friday, 7 a.m. — 8 p.m. US Eastern Time:

  • Chat Now

    Note that password resets and user information are not available through Live Chat or Email. Instead, please call the main toll-free number below.

  • 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

For service or support

Get all the information you need in one place—from customer support to sales, operations, and more.

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