As a relatively low-risk, high-return activity, claims fraud holds particular appeal for organized crime syndicates, who account for a growing proportion of insurance fraud. Unfortunately, most fraud detection solutions uncover fraud based on a single claim or customer in isolation and are unable to identify claims associated with organized fraud. SAS can change that. How the SAS® Fraud Framework for Insurance Can HelpThe SAS Fraud Framework for Insurance is designed to detect and prevent opportunistic and organized claims fraud. The framework includes components for: Detection and Alert Generation
SAS provides solutions that: - Enable the systematic detection of suspicious activity using a combination of different analytics techniques to determine the likelihood of claims fraud.
- Includes a fraud scoring engine that is designed to detect fraud for auto, home and workers compensation lines of business and can be extended easily to support other lines of business as needs arise.
Alert Management
SAS offers alert management capabilities that enable you to: - Assemble alerts from multiple monitoring systems, associate them with common claimants and provide investigators with a more complete perspective on the risk of a particular claimant or individual.
- Perform additional tasks, including:
- Risk score calculation. Each alert generated is assigned a risk score based on the specific characteristics of the activity, with transparent reason codes.
- Alert prioritization. Prioritizes and routes potentially fraudulent claims to appropriate team members, resulting in greater efficiency, increased detection rates and reduced losses.
- Work assignment. Organizations can appoint automated alert assignments to various investigators or analysts based on rules and requirements set by the user.
Social Network Analysis
With the SAS Social Network Analysis solution, you can: - Uncover previously hidden linkages that might otherwise go undetected.
- Detect and prevent fraud by going beyond individual and account views to analyze all related activities and relationships at a network dimension.
Read the SAS Social Network Analysis product brief for insurance. (PDF) Case Management
Case management capabilities from SAS let you: - Systematically facilitate investigations and capture and display all information pertinent to a case.
- Store information regarding fraudulent activity, including interview notes and evidence needed for criminal or civil prosecution, restitution and collections.
- Access information on your organization's overall fraud exposure, including losses due to fraud as well as fraud detected or prevented.
- Facilitate assignment of cases to investigators.
- Configure workflows for the management and resolution of cases
How the SAS® Fraud Framework for Insurance Is DifferentNo other fraud solution provides the same level of detection, automation, ease of use and ROI for claims fraud. The SAS Fraud Framework for Insurance: - Provides enhanced fraud detection and greater insight into opportunistic and organized claims fraud across all lines of business, including auto claims and warranty fraud.
- Measures the likelihood of a claim being fraudulent at each stage of the claims process with an anti-fraud analytical engine that uses a combination of techniques to assign each claim a fraud score.
- Improves operational efficiency by creating alerts for suspicious claims and routing them to special investigation units where investigators can use case management tools to investigate rapidly before losses occur.
- Helps insurers decrease fraud losses, lower loss-adjustment expenses and improve their competitive position through a consolidated view of fraud risk.
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