Claim fraud is an unfortunate reality when managing claims, but analytical techniques can assist in the identification of these claims.
The Claim Lab has developed a number of advanced modeling processes which can be used to automatically highlight claims which are at risk of fraud.
Process 1, analyses the key characteristics of claims that have previously been investigated by your Special Investigation Unit and identifies claims with the same profile. These claims are highlighted on reports provided by The Claim Lab.
Process 2, looks for claims that do not fit the profile expected. These are outliers, as measured on a number of key factors, and highlights the claim for further consideration. There may be a very good reason for the claim not fitting a regular profile, but also there may be fraudulent activity.
Process 3, is a softer approach to claim fraud. This looks at claims that may have started off as legitimate claims, but now no longer meet that criteria. This can be referred to as ‘malingering’ but its still fraud!
The Claim Lab would be happy to discuss these techniques with you in more detail.
The Claim Lab – Email us at firstname.lastname@example.org