SAS^® Fraud Framework for Insurance

Detect more fraudulent activity.

SAS gives you a broader view by processing all data through advanced analytics models and combining it with rules engines. You’ll be able to detect previously unknown schemes with customized anomaly detection methods, and spot linked entities and crime rings to stem larger losses.

Prevent fraud losses before settlement.

Real-time daily batch scoring catches fraud immediately. Find loss padding in similar claims. Identify repeat offenders and uncover insider or collusive fraud by integrating staff data and audit records, and applying risk- and value-based scoring models to prioritize output for investigators.

Lower loss-adjustment expenses.

You can greatly reduce false positives using our sophisticated fraud scoring engine. Improve investigator efficiency and ROI with advanced case management tools and by prioritizing higher value networks and conducting more efficient and accurate investigations. Capture all claims settlement amounts within the system to 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 techniques.

Gain a greater competitive advantage.

Generate fewer false positives to gain greater satisfaction of legitimate customers. More diligent, effective fraud detection methods can actually discourage fraudsters from targeting your organization. And satisfy regulatory requirements by better managing fraud.

• Fraud data management. Consolidate historical data from internal and external sources for fraud analysis and investigation.
• Rule and analytic model management. Create and logically manage business rules, analytical models and alerts of known fraudster lists for investigators.
  
• Detection and alert generation. Score claims in near-real time with an online scoring engine that combines business rules, anomaly detection and advanced analytic techniques.

• Alert management. Combine alerts from multiple monitoring systems, associate them with common claimants and give investigators a more complete perspective on the risk of specific claimants.
• Social network analysis. Identify linkages among seemingly unrelated data and uncover previously unknown relationships.
• Case management. Streamline operations with a systematic means of conducting investigations using a configurable workflow.