ClaimDirectorSM

Detect claims fraud quickly and accurately with predictive analytics

Insurers need to determine quickly and efficiently whether a claim is likely to be fraudulent—or if it can be fast-tracked for settlement. ClaimDirectorSM uses the power of predictive analytics to score claims with greater accuracy and reveal questionable attributes.

Claims fraud detection that stays ahead of fast-evolving schemes

 

Claims fraud detection that stays ahead of fast-evolving schemes

Accelerate fraud detection and triage claims with confidence. Discover how ClaimDirectorSM leverages machine learning, extensive data sets, and predictive models to score claims for potential fraud.

Focus your fraud detection with customized loss scenarios

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Focus your fraud detection with customized loss scenarios

Build custom, fraud rule scenarios with ClaimDirector Architect. This new, innovative tool is an add-on to ClaimDirector. Test ideas in a sandbox environment using ClaimDirector business rules and other data points for more efficient and flexible claims fraud detection. The enhancement allows you to:

  • Create targeted alerts for your modeling
  • Respond quickly to emerging trends
  • Collaborate internally with data scientists to optimize scoring

Operationalize fraud analytics in days, not months

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Operationalize fraud analytics in days, not months

  • Native integration with ISO ClaimSearch®
  • SaaS delivery with no IT lift/ETL work
  • Standard implementation in less than a week
  • Flexible delivery channels; claim system integration via APIs

Improve claims triage with AI-powered models

ClaimDirector leverages machine learning predictive models to deliver highly accurate claim scores and actionable reason codes to support faster triage, evaluation, or settlement. The solution helps detect potential fraud early by:

  • Generating highly accurate scores and enhanced reason codes
  • Using multiple variables to identify claims for further investigation
  • Comparing claims to more than 1.5 billion records in ISO ClaimSearch®
  • Leveraging third-party data sets and civil and criminal records
  • Tuning predictive models to company-specific investigative results
  • Using fraud scenarios to give SIU meaningful context for model output

Property/casualty insurance fraud costs insurers $30 billion a year

Claims Fraud Analytics

Property/casualty insurance fraud costs insurers $30 billion a year

Illuminate unseen claims fraud with advanced analytics

Are you getting the right results from your fraud analytics?

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Learn how fraud scenarios enhance your investigations and improve model output.

Download the brochure

Get visual insights to improve investigations

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Get visual insights to improve investigations

ClaimDirector provides SIU and business intelligence dashboards for visual analysis.

  • Review scored claims in real time; prioritize and filter thresholds for SIU focus
  • Get deep insights into reason codes that develop scores
  • View questionable claim exposures within your book of business geographically
  • Get insights into loss history dynamics via ISO ClaimSearch

Leverage AI in fraud detection

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Leverage AI in fraud detection

Incorporating sophisticated tech such as AI, machine learning, and predictive analytics in fraud analytics requires four critical data components: variety, value, volume, and velocity. Do you have the data to keep pace?

For more Verisk claims fraud solutions, check out:

Fight organized insurance fraud with advanced link analysis

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Fight organized insurance fraud with advanced link analysis

Discover the hidden connections among claimants, providers, and businesses to help identify organized insurance fraud. NetMap’s advanced analytics greatly enhance the SIU’s ability to discover fraud rings within their company’s claims. The software quickly evaluates claim information, public records, and other data to reveal patterns indicative of fraud.

Get missing details to complete claims

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Get missing details to complete claims

Find the critical data you need at FNOL (first notice of loss) to help complete claims quickly and spot potential fraud. Decision Net® helps fill in the gaps with supplemental claims information from best-in-class sources. This extensive resource helps claims teams improve decision making, expedite meritorious claims, and increase the impact of SIU referrals.

Identify medical provider fraud quickly and accurately

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Identify medical provider fraud quickly and accurately

Insurers need to detect unethical medical billing practices early to reduce claim leakage and process legitimate bills faster. ISO MedSentry® uses predictive analytics and expert clinical analysis to uncover fraudulent medical provider fraud in your billing data. It also delivers detailed reports to help guide investigations.

Improve investigation case management and eliminate inefficiencies

Case Manager

Improve investigation case management and eliminate inefficiencies

Special investigations units are experiencing new challenges with complex cases, increased fraud, and stringent regulatory requirements. Case Manager™ is a fully configurable fraud management solution that improves productivity and efficiency by automating triage, assignment, and compliance reporting.

Contact Us to Learn More

Other Ways to Connect

We are available Monday through Friday, 7 a.m. — 9 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

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