SAS^® DETECTION AND INVESTIGATION FOR INSURANCE

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

With SAS^®Detection and Investigation for Insurance, you don't have to accept claims fraud as a cost of doing business.

Detect more fraudulent activity.

Identify suspicious activity, uncover hidden relationships and detect subtle patterns of behavior at every stage of the claims process. Our insurance fraud analytics engine uses multiple techniques (automated business rules, embedded AI and machine learning methods, text mining, anomaly detection and network link analysis) to automatically score millions of claims records in real time or in batch. Customized anomaly detection methods reveal previously unknown schemes, linked entities and hidden crime rings, which can help stem larger losses.

Get a consolidated view of fraud risk.

Identify linkages among seemingly unrelated claims, and identify cross-product fraud. A unique visualization interface lets you see customer claims and policies for all lines of business, and analyze all related activities and relationships at a network dimension. Social network diagrams and sophisticated data mining capabilities give you a better understanding of new fraud threats, enabling you to prevent substantial losses early. And you can stay on top of changing claims fraud trends by continually improving models and adapting the system.

Lower loss-adjustment expenses, and gain a greater competitive advantage.

A sophisticated fraud scoring engine enables you to identify claims fraud with greater speed and accuracy. By quickly determining which claims require further scrutiny and which ones don't, you can significantly reduce false positives – which means a better customer experience. Automatic scoring lets you prioritize higher-value claims, entities and networks, while advanced case handling tools enable more efficient, effective investigations – and a higher ROI per investigator. In addition, all claims settlement amounts are captured within the system for reuse with similar claims in the future.

KEY FEATURES

A single, end-to-end framework uses multiple techniques – automated business rules, predictive modeling, text mining, exception reporting, network link analysis, etc. – to better identify fraudulent activity and stop payments before they are made.

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 & 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 & 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 related activities and relationships at a network dimension.

Search & 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. Offers highly secure hosting for your sensitive information. SAS is certified and experienced in handling sensitive medical (HIPAA), financial/personal (PII) and tax (IRS publication 1075) data.

Full Features List