Solution Overview

Claims fraud analytics service

AI and machine learning to cut fraudulent claims

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In the US alone, insurance fraud costs insurers a shocking $32 billion every year. But detecting, investigating, and preventing fraud is a massive challenge for even the most mature special investigation unit (SIU).

Our claims fraud analytics service uses predictive modeling and over 600 business rules to identify, score, and prioritize possible cases of fraud. It not only reduces insurers' fraudulent claims payouts, but also helps them avoid reputational damage or loss of customers due to premium increases.

How does it work?

Deployed in the cloud or onsite, our fraud service uses AI and machine learning to do the heavy lifting. That way, clients' SIU resources can focus on the most high-value, high-probability cases of fraud. Our fraud services work by:

  • Advanced analytics runs all suspicious claims through one or more risk models
  • Triage analysts review and and analyze the data and refers cases with the highest risk score to the SIU team
  • Scored but rejected claims are used to recalibrate models to improve efficiency and accuracy
  • A case management suite helps investigators keep track of their assigned claims 
  • A layered voice analysis tool evaluates and measures callers' emotions during first notice of loss calls
  • A link analysis tool provides investigators with additional leads, analysis and insights from the claims data
  • A visualization suite enables SIU managers to track and reward team member performance Using a continuous scoring framework which triggers algorithm scoring starting at FNOL and then when new information becomes available on a claim

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It's a win-win for customers and insurers

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Our end-to-end smart claims approach consists of modular offering built on our Genpact Cora platform

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Genpact and claims

Ever-increasing auto and natural catastrophe claims. Rising customer service demands. Aging legacy systems. These are just some of the challenges facing insurers that digital technologies like automation, AI, and analytics can help tackle. Our digital tools optimize the balance between customer satisfaction, accurate loss assessment, and loss adjusting expenses, with solutions that span the claims journey, handling everything from fast-track claims processing to fraud and subrogation analytics. You can start with the module that addresses your biggest challenge and add from there. Or we can run your entire claims operation.

Global insurers and reinsurers, surplus lines insurers, a European insurer, even a top-10 Fortune company – we've transformed claims for them all over the past 15 years. We combine the digital understanding of an insurtech with claims expertise and business process know-how. Let's put this to work for you.

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