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| Fraud Modeling Business Requirements and Design: |
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Claims Fraud Modeling.
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| Overview |
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- Current fraud detection and prevention methods are manual and inconsistent allowing a significant proportion of fraudulent claims to be paid.
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Our Approach |
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- Designed an automated system to augment the adjuster referral process and improve both quantity and quality of referrals
- Predictive modeling to rank claims according to statistical likelihood of fraud.
- Business rules evaluation to check claims for known fraud indicators and red flags
- Link and Cluster Analysis to identify patterns across claims that show organized fraud.
- Automated workflow to route claims through the most efficient process based on fraud probability.
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Outcome |
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- SIU resources will be able to focus their efforts on claims with a much higher likelihood of containing fraud.
- Claim Adjusters will be able to improve customer service by expediting claims with a low probability of fraud..
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| Copyright - TNC Management Group LLC © 2009 |
45 Park Place South, #301, Morristown, NJ 07960 | 1-888-821-1115 |
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