FraudFocus®

FraudFocus helps 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

Improve Fraud Detection
FraudFocus automates and standardises the fraud detection process, providing a new level of consistency and efficiency when searching for potential fraud.

Identify Potential Fraud Early
Compare each claim, provider or policy to historical fraudulent patterns, identifying the likelihood of fraud at the earliest possible moment.

Optimize Processes
Gain reporting, tracking and analysis tools to identify trends and optimize the fraud referral and mitigation process.

Benefits

  • Review claims, providers or policies for subtle patterns which may be indicators of fraud using techniques more powerful than traditional red flags or rules alone.
  • Compare individuals and organizations with internal and third-party lists to flag matches of similar identities.
  • Prioritize and organize claims so the most appropriate actions are taken through automated special investigative unit referrals or specialist notifications.
  • Receive alerts when claims thresholds are exceeded.
  • Track, analyze and report on trends to optimize your fraud referral and mitigation process.

Features

  • Predictive model scoring – uses predictive analytic and data mining techniques to find subtle patterns which may be indicators of fraud in internal data and prioritises each claim, provider or policy based on the likelihood of fraud.
  • Business rules – automatically detects 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.

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