FraudFocus®

Identify the likelihood of fraud at the earliest possible moment

FraudFocus® is an effective fraud detection system that helps insurance companies proactively combat several types of fraud:

  • Claims: Identifies claims that have a high probability of being fraudulent.
  • Medical providers: Identifies medical providers with suspicious billing activity or unusual treatment patterns.
  • Premium: Identifies policies with discrepancies or irregular combinations.

FraudFocus® automates and standardises the fraud detection process, providing a new level of consistency and efficiency when searching for potential fraud. FraudFocus® compares each claim, provider or policy to historical fraudulent patterns, identifying the likelihood of fraud at the earliest possible moment.

  • Reviews each claim, provider or policy for subtle fraudulent patterns using techniques more powerful than traditional red flags or rules alone.
  • Reviews each claim and provides alerts when thresholds have been exceeded.
  • Compares individuals and organisations to internal and third-party lists to flag matches of similar identities.
  • Prioritises and organises claims so the most appropriate action can be taken through automated special investigative unit referrals or specialist notification.
  • Provides reporting, tracking and analysis tools to identify trends and optimise the fraud referral and mitigation process.

FraudFocus® uses the following technology:

  • Predictive model scoring uses predictive analytic and data mining techniques to find subtle fraudulent patterns in internal data and prioritises each claim, provider or policy based on the likelihood of fraud.
  • Business rules automatically detect when pre-determined business rules have been violated and provides alerts.
  • Identity matching manager automatically matches individuals, organisations, addresses and other identifiers to internal lists and third-party data sources, even when data is missing or incomplete, and consolidates the results from all matches in an easy-to-read format.
  • Reporting engine provides standard Web-based management and operational reports. Customised reports are also supported via the FraudFocus analytical data mart.

Contact

Swati Vikram
+91 77381 28556

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