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.

  • Review each claim, provider or policy for subtle fraudulent patterns using techniques more powerful than traditional red flags or rules alone.
  • Review 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.
  • 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.