Insurance Fraud

With insurance fraud hitting the headlines worldwide and costing organizations multi-millions in false claim payments, insurers are rapidly realizing the benefits of adopting sophisticated, automated fraud detection technologies and are abandoning manual techniques.

Norkom’s insurance fraud product - part of the financial crime and compliance suite – provides a highly effective fraud detection solution which delivers fraud screening and speedier processing of genuine claims as well as efficient identification and investigation of red flags.

Fraud screening detection scenarios utilizing advanced analytical techniques enable accurate profiling and risk rating of claim details. These can be extended and reconfigured as business requirements evolve. Fuzzy matching is used to match claims data against internal and external data and sophisticated link analysis works to uncover hidden relationships and spot organized and opportunistic fraud attempts.

And the end result? - Streamlined and cost effective investigations which reduce operational costs and speed up the processing of genuine claims while reducing fraud losses.

Profile and Detect

Specialized fraud screening analytics assign red or green flag status

 

By applying Norkom’s analytical modelling techniques, a risk profile is generated for each individual claim including a fraud propensity score and a comprehensive behavior profile of each relevant party, policy or claim.

The risk profile of the claim is assessed and assigned a green or a red flag risk rating using a combination of specialized fraud screening analytics and pre-defined detection scenarios.

Using this combination of analytical techniques Norkom’s insurance fraud solution enables genuine claims to be processed more efficiently and directs claims analysts to focus on those potentially fraudulent claims with the highest priority. The product is populated with pre-defined detection scenarios developed specifically for the insurance sector enabling faster deployment and maximizing return on investment.

InvestigateFully populated and prioritized red flags delivered direct to investigators’ desktops

Rapid investigation is enabled by Norkom’s case management which delivers fully populated and prioritized red flags with information including case details, audit history, documents captured, diarized events and linkage to fraud cases.

Fully configurable workflow and a detailed audit log of all investigated fraud incidents is provided together with access to the information on all other claims - some of which may then prove to be fraudulent based on subsequent analysis.

Norkom’s insurance fraud product is dynamic in nature. Based on the ongoing monitoring of investigations and processed claims, accurate modeling enables management of the highest priority claims and reduces false positives. Refreshing and tuning of the detection scenarios enables active refinement of the risk ratings which are used to determine red flags. This is actively supported by our model management and automated drift monitoring and detection capabilities.

ReportStandard and configurable business reports and analytics generated automatically

 

Understanding the effectiveness of your fraud detection and prevention activities is key to improvement.  Automated business reports allow you to monitor the effectiveness of your fraud management processes while our analytical capabilities enable the analysis and refinement of detection scenarios, profiles and predictive models.

Norkom's comprehensive insurance fraud product minimizes your financial losses and reduces your operational costs.