You don't have to accept claims fraud as a cost of doing business. SAS® Detection and Investigation for Insurance provides an end-to-end solution for detecting, preventing and managing both opportunistic and organized claims fraud across multiple lines of business, with components for fraud detection, alert management and case handling.
Key Features
- Data management. Includes an insurance-specific data model that consolidates data from internal and external sources – claims systems, watch lists, third parties, unstructured text, etc. – and seamlessly integrates existing solutions.
- Advanced analytics with embedded AI. Provides a broad set of advanced analytic and AI techniques, including modern statistical, machine learning, deep learning and text analytics algorithms – accessible from a single environment.
- Rule and analytic model management. Includes prepackaged heuristic rules, anomaly detection and predictive models, and lets you create and logically manage business rules, analytic models, alerts and watch lists.
- Detection and alert generation. Calculates the propensity for claims fraud at first submission with a scoring engine that combines business rules, anomaly detection and advanced analytics; then rescores claims at each processing stage as new claims data is captured.
- Alert management. Combines alerts from multiple monitoring systems and associates them with common individuals for a more complete view of risk for individuals or groups.
- Social network analysis. Provides a unique visualization interface that lets you go beyond transaction and detailed claims views to analyze all related activities and relationships at a network dimension.
- Search and discovery. Lets you perform free-text, field-based or geospatial searches across all internal and external data, and refine searches using interactive filters.
- Case handling. Streamlines operations with a configurable workflow that provides a systematic means of conducting investigations, and captures and displays all information pertinent to a case.
- Flexible deployment options. Enables you to choose the deployment option that works best for you – complete hosting by SAS, deployment at your site or a combination of the two.
This solution runs on SAS® Viya®, which has the breadth and depth to conquer any analytics challenge, from experimental to mission critical. SAS Viya extends the SAS Platform to enable everyone – data scientists, business analysts, developers and executives alike – to collaborate and realize innovative results faster.
