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Claims Fraud

In the UK alone, insurance companies paid out nearly £2 billion last year on fraudulent claims. Add to that the cost of investigating 'false positive' claims and expensive delays in processing legitimate claims and it can mean only one thing: higher, less competitive premiums.

But detecting fraudulent claims presents numerous challenges. Alongside the opportunists, many fraudsters belong to professional crime rings attracted by perceived low risks and high returns. They test rules and thresholds to find ways of operating under the radar. And they constantly change elements of their identities, making it difficult to match new claims to known fraudsters. Detection often depends heavily on the instincts of an experienced claims handler.

With the right technology, though, you can identify more fraud, earlier. By relentlessly monitoring and analysing every byte of your data, fraud prevention from SAS can make even the most subtle patterns and connections - the fingerprints of fraud - instantly visible.

White Paper

Enterprise Case Management: A structured framework and approach for holistic management of fraud, waste, abuse and improper payments

How SAS Can Help

SAS collates, analyses and reports on hundreds of thousands of variables, using advanced mathematical models.

  • Find fraud before claims are made: Use business rules, predictive analytics and social network analysis to uncover hidden relationships, detect suspect behaviour, prioritise suspicious cases and predict future risks.
  • Detect unknown fraud: Correlate data with known fraudulent claims to discover relationships that can be used to monitor future claims or discover new types of fraud.
  • Reduce false positives: Our advanced scoring engine uses independent and combined scores - including scoring associated networks - for more accurate results.
  • Improve investigator efficiency: Advanced case management tools and an intuitive interface let investigators visualise data from multiple angles, perform interactive queries and generate meaningful reports on all the networks surrounding a case.
  • Reduce settlement costs: Because non-suspicious patterns that indicate low risk are separated from suspicious high risk ones, legitimate claims can be settled more efficiently.
  • Measure program performance: Our desktop dashboard lets you set and monitor key performance metrics - so you can see how effective and efficient your fraud prevention programmes are at a glance.
  • Improve data quality: SAS integrates disparate data (including third-party sources) and uses embedded data quality techniques to improve its accuracy.
 

Ready to learn more?

Call us at 01628 486 933 (UK) or request more information.

 

 

Questions?

 

Whitepaper

Enterprise Case Management: A structured framework and approach for holistic management of fraud, waste, abuse and improper payments.