SAS Fraud Decisioning for Claims

Detect, prevent and manage insurance claims fraud across all lines of business.

Don't accept insurance claims fraud as a cost of doing business.

Reduce leakage by detecting more fraudulent claim activity.

Identify suspicious activity and detect subtle patterns of behavior from first notice of loss (FNOL) to approval or denial. Stem potentially large claims fraud losses with visibility to previously unknown schemes, hidden relationships and covert crime rings. SAS Fraud Decisioning for Claims scales to millions of records, pinpointing claims fraud across them instantly using multiple analytic techniques and customized anomaly detection.

Consolidate your view of claims fraud risk across all lines of business.

Built on a single, cloud-native platform, SAS Fraud Decisioning for Claims unites the insurance claims fraud process, from data management to decision and reporting, in an intuitive interface. Its claims fraud control center provides a 360-degree view of the policyholder across all lines of business, so interconnected relationships and activities are visible across claims and policies – enabling collaboration across fraud teams. And SAS Fraud Decisioning for Claims helps you stay on top of claims fraud trends through continuous model improvement and rapid model deployment.

Lower loss-adjustment expenses while gaining greater competitive advantage.

Improve the customer experience on legitimate claims without sacrificing profit. Our sophisticated fraud scoring engine identifies potential claims fraud accurately to facilitate straight-through processing and other claims automation initiatives. Higher detection accuracy reduces false positives, speeds payment of valid claims, and increases policyholder satisfaction. Automatic scoring also prioritizes higher-value claims, entities and networks, while advanced case and intelligence management tools enable more efficient, effective investigations – all leading to a higher ROI per investigator. Storage of all claims settlement amounts allows for future reuse, reducing reliance on internal knowledge.

Key Features

A single, end-to-end platform using multiple analytic techniques to better identify fraudulent claims activity and stop payments before they are made.

Data management

Includes an insurance-specific claims fraud data model that consolidates data from internal and external sources – claims systems, watch lists, third parties, unstructured text and others – and seamlessly integrates into existing solutions.

Advanced analytics & embedded AI

Provides a broad set of advanced analytic and AI techniques, including modern statistical, machine learning, deep learning and text analytics algorithms in a single environment.

Rule & analytic model management

Includes prepackaged insurance-specific rules, anomaly detection and predictive models, with the ability to create and logically manage business rules, analytic models, alerts and watch lists.

Detection & alert generation

Scores claims for fraud at first submission, and rescores at each processing stage as new claims data is captured.

Alert management

Combines alerts from multiple monitoring systems and associates them with individuals for a more complete view of the individual’s and group’s risk.

Social network analysis

Goes beyond transaction and detailed claims views to show the network of related activities and relationships.

Search & discovery

Lets you perform free-text, field-based or geospatial searches across all internal and external claims data, and refine using interactive filters.

Case & intelligence management

Streamlines operations with a configurable workflow for systematic, repeatable claims fraud investigations, and captures and displays all pertinent case information.

Flexible deployment options

Meets your deployment needs: Turn your insurance claims fraud detection over to SAS in a hosted managed service deployment on Microsoft Azure infrastructure; let SAS remotely manage deployment while you keep the data in your preferred cloud; or choose a combination of the two. SAS Cloud-managed application services deliver fast time to value and high availability. Or deploy on-site if you want to manage and maintain your own environment. Regardless of how you deploy, you get a SAS solution tailored to your organization’s specific requirements.

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