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.
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.
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.
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.