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.
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.
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:
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:
Illuminate unseen claims fraud with advanced analytics
Learn how fraud scenarios enhance your investigations and improve model output.
ClaimDirector provides SIU and business intelligence dashboards for visual analysis.
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?
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.
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.
Insurers need to detect unethical medical billing practices early to reduce claim leakage and process legitimate bills faster. 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.
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.
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