Products & Solutions / Service Intelligence

SAS® OnDemand: Suspect Claims Detection

Optimize auditor time and reduce service costs

SAS® OnDemand: Suspect Claims Detection analyzes service claim data to identify suspicious claims and service providers. Using dozens of automated analytic models built on the SAS Fraud Framework, the solution goes beyond traditional business rule engines to allow manufacturers and retailers to focus their auditors on the most likely sources of fraud. With the SAS OnDemand delivery method, business results are gained rapidly with minimal IT investment distributed predictably over time.

Benefits

  • Reduce service costs.
  • Maximize effectiveness of auditors’ time.
  • Improve service network effectiveness.
  • Analyze and optimize parts usage.
  • Short time to implementation.

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Features

  • Scoring.
  • Data and text mining with predictive models.
  • Dispositioning.
  • Hosted solution.
  • IT and analytics expertise.
  • Flexibility.

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" Now that we're addressing suspicious claims activity, we're looking for other ways to use analytics to improve the consumer experience."

—Julie Tisera

Consumer Experience Manager

GE Consumer & Industrial

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Rank flagged claims and service providers based on the likelihood of fraud.


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How SAS® Is Different

  • Only SAS combines business rules, statistical tests and analytical models to significantly increase suspect claim recovery.
  • Detect issues and eliminate waste while not disrupting the adjudication process or slowing payments due for legitimate service; results are available in minutes – before the claim is paid.
  • Gain a rapid return on investment with such a short implementation time – receive superior business intelligence without the large up-front investment of in-house system development.
  • By focusing auditors on the most suspicious service providers and claims, their time is used more effectively, and their productivity increases.

Benefits

  • Reduce service costs. By denying or charging back for illegitimate claims, service costs can be greatly reduced. Illegitimate claims can decrease from service providers becoming aware of being monitored.
  • Maximize effectiveness of auditors’ time. Auditors are able to focus on the claims and service providers with the highest probability of fraud.
  • Improve service network effectiveness. Automated claim review uncovers patterns of inefficiency where service providers can improve their performance and enhance end-user satisfaction.
  • Analyze and optimize parts usage. Automated analytics detect patterns of parts usage that can be utilized to retrain technicians and save parts costs.
  • Short time to implementation. The solution is hosted on a secure, shareable and scalable infrastructure specifically designed for detection of suspect claims, without the up-front IT investment, staff and maintenance costs.

Features

Scoring.
  • Automatically processes 100 percent of claims filed to detect suspicious ones.
  • Scores claims and service providers based on the likelihood of fraud for auditor evaluation.
  • Highlights specific business rules and analytic models to guide auditors in their investigations.
Data and text mining with predictive models.
  • Identifies invalid or incomplete claims.
  • Finds claims that are beyond normal variation.
  • Learns from historical audit data.
  • Detects patterns in data and text that indicate suspicious behavior.
Dispositioning.
  • Enables users to approve, deny, flag for audit, etc., specific claims and service providers.
  • Sets status for multiple claims and service providers simultaneously.
Hosted solution.
  • Delivered with a secure, high-performance data processing infrastructure.
  • Guaranteed 99 percent or greater availability in service-level agreements.
  • Experienced SAS staff assists with hardware selection and staging, off-site backups, security and scheduled upgrades.
IT and analytics expertise.
  • Industry-leading business analytics support from the SAS Advanced Analytics Lab.
  • Access the right expert at the right time for optimizing the infrastructure, the data warehousing foundation and the business analytics applications.
Flexibility.
  • No up-front technology investments.
  • Manage risk and scale for growth as your strategy dictates.
  • Gain financial flexibility to pay monthly subscription fees by way of operating expense budgets.

Screenshots

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Rank flagged claims and service providers based on the likelihood of fraud.

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Drill into details on specific claims and service providers.

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Approve, deny or audit individual clalims or service providers.

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Ready to learn more?

Call us at 1-800-727-0025 (US and Canada) or request more information.