Reduce costs and improve operational efficiencies by getting the right claim to the right people at the right time with LexisNexis® Claims Solutions.
LexisNexis' comprehensive, data-driven claims processing solutions help you identify high-risk claims earlier and move claims more effectively through the process, saving you valuable time and money.
In an increasingly competitive and challenging climate, our solutions help you achieve and maintain operational excellence by enabling insurers to:
- Make the right decisions on a daily basis
- Assign specialists to high-risk claims earlier
- Reduce case shelf life
- Reduce allocated expenses
- Improve outcomes
- Advanced Data and Analytics for Property Casualty Insurance—the Cure for the Medical Provider Claims Fraud, Waste and Abuse Epidemic
Many industry organizations estimate that fraud, waste, and abuse by medical providers cost the insurance industry hundreds of billions annually. It's a devastating epidemic that's gaining momentum. But now there's a prescription.
In order to help insurers address the fraud problem, our claims experts have developed a white paper, Advanced Data and Analytics for Property Casualty Insurance—the Cure for the Medical Provider Claims Fraud, Waste and Abuse. Within, we examine how powerful new data analytics can empower insurance companies to detect, investigate, and deter potential fraud.
- More Data, Earlier: The Value of Incorporating Data and Analytics in Claims Handling
At other points in the insurance policy lifecycle, P&C carriers have implemented real-time data and analytics to enhance risk management, streamline processes and reduce costs. Yet historically within the claims function, data and analytics have mostly been isolated to the special investigative unit (SIU). We conducted a study to investigate the effect of having more data earlier in the claims process and found that claims with more data are resolved faster, with lower overall costs. Learn how carriers can use data and analytics as an operational tool first, and an investigatory tool second.
- How Analytics Can Help Carriers Weather Challenges: LexisNexis® Insurance Solutions
Insurance carriers are facing three critical, converging challenges:
Analytics can help. By leveraging a carrier's historical data and external data sources such as police reports and public records, insurers can apply analytic and statistical tools to create automated workflows that can be implemented into the claims process to assist claims adjusters.
- The pending retirement of their most experienced claims adjusters associated with the aging baby boom generation;
- Slow manual processes within their claims business that are outdated when compared to the investment in IT and automation on the new business and underwriting side; and
- Lengthy decision processes that challenge claims executives to continually do more work with less while also improving customer satisfaction.
In this paper, readers will learn how analytics can help:
- Incorporate best practices into an insurance organization by identifying and using behavior patterns within the data.
- Quickly deliver the right data and recommendations to the right people at the right time using automation.
- Efficiently route claims to people with the appropriate skills by simply changing the decision parameters in the claims process and monitoring their effectiveness.
- The Evolution of Insurance Fraud Detection: Lessons Learned from Other Industries
At a cost of nearly $80 billion annually, claims fraud is a top concern among insurers. However, considering the high volume of claims and the elusive nature of fraud, how can companies continually improve fraud identification without incurring additional costs associated with tripling or quadrupling their staffs?
The credit card and telecommunications industries, with traits similar to the insurance industry and which also faced big fraud issues, offer much needed insight into how insurance organizations can efficiently combat this expensive problem.
This paper examines how the credit card and telecommunications industries addressed fraud by replacing manual fraud identification processes with sophisticated, real-time fraud detection technology using a four-phased pattern of process change and technology adoption that included:
- Phase I: Manual review
- Phase II: Automated exception processing
- Phase III: Front-end business rules and scorecards
- Phase IV: Real-time predictive pattern recognition and detection