SAS® Fraud Framework for Insurance

SAS® Fraud Framework for Insurance

Detecting, preventing and managing claims fraud across all lines of business

Fraud costs the P&C industry $30 billion each year in the US alone, and that figure is projected to rise as both opportunistic and professional fraud continue to grow.

It is estimated that more than 10 percent of all insurance claims are fraudulent, but insurers often accept fraud as a cost of doing business since it isn't cost-effective to pursue fraudulent claims after settlement. That's why SAS developed the SAS Fraud Framework for Insurance, an end-to-end solution for preventing, detecting and managing claims fraud across the various lines of business within today's insurers.

Benefits

Detect more fraudulent activity than ever before.

  • Insert advanced analytics into the process, in addition to rules engines.
  • Process all claims data (not just a sample) through rules and analytical models in real time or in batch.
  • Use customized anomaly detection methods to detect previously unknown schemes.
  • Spot linked entities and crime rings, which can help stem larger losses.
  • Overcome poor data quality issues associated with imperfect matching and highly linked entities.

Prevent fraud losses before settlement.

  • Stop fraud before claims are paid using online real-time scoring or daily batch scoring.
  • Detect loss padding in similar claims using anomaly detection and loss comparisons.
  • Identify repeat offenders and more accurately score incoming claims by searching databases of known fraudsters and capturing all fraud outcomes, referrals and suspects within the system for reuse.
  • Uncover insider or collusive fraud by integrating staff data and audit records that show who handled which claims.
  • Apply risk- and value-based scoring models to prioritize output before presenting to investigators.
  • Insert analytical models into your process workflow, enabling real-time access to information.

Lower loss-adjustment expenses.

  • Greatly reduce false positives using a sophisticated fraud scoring engine.
  • Improve investigator efficiency with advanced case management tools.
  • Increase investigator ROI per investigator by prioritizing higher value networks and conducting more efficient and accurate investigations.
  • Capture all claims settlement amounts within the system for reuse with similar claims in the future.

Gain a consolidated view of fraud risk.

  • Identify cross-brand/product fraud by seeing customer claims and policies for all lines of business.
  • Continuously improve models and adapt the system as needed to address changes in fraud trends.
  • Understand new claim threats and prevent substantial losses early using social network diagrams and sophisticated data mining capabilities.

Improve your competitive position.

  • Generate fewer false positives, which leads to greater customer satisfaction for legitimate customers.
  • Drive fraudsters to target other insurers with less diligent and effective fraud detection methods.
  • Satisfy regulatory and rating agency requirements through enhanced fraud management.

Screenshots & Demos

Features

Fraud Framework for Insurance
  • Fraud data management
  • Rule and analytic model management
  • Detection and alert generation
  • Alert management
  • Social network analysis
  • Case management
CNA
The implementation of such groundbreaking technology and its impact inspires confidence and gratitude among our customers.

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