ClaimDirector
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
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
Operationalize fraud analytics in days, not months
- Native integration with 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 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
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?
Learn how fraud scenarios enhance your investigations and improve model output.
Get visual insights to improve investigations
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 ClaimSearch
ClaimDirector Dashboard
For more Verisk claims fraud solutions, check out:
Fight organized insurance fraud with advanced link analysis
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
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
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. 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.