1. Microsoft Dynamics CRM

SAS với giải pháp chống gian lận ngành bảo hiểm

Discussion in 'Bảo hiểm' started by bsdinsight, Dec 28, 2014.

  1. bsdinsight

    bsdinsight Well-Known Member

    SAS Fraud Framework for Insurance1.jpg

    Don't accept fraud as a cost of doing business. We can help you reduce fraud-related losses and lower false positives while gaining greater investigator efficiency.

    Detect more fraudulent activity.
    SAS gives you a broader view by processing all data through advanced analytics models and combining it with rules engines. You’ll be able to detect previously unknown schemes with customized anomaly detection methods, and spot linked entities and crime rings to stem larger losses.

    Prevent fraud losses before settlement.
    Real-time daily batch scoring catches fraud immediately. Find loss padding in similar claims. Identify repeat offenders and uncover insider or collusive fraud by integrating staff data and audit records, and applying risk- and value-based scoring models to prioritize output for investigators.

    Lower loss-adjustment expenses.
    You can greatly reduce false positives using our sophisticated fraud scoring engine. Improve investigator efficiency and ROI with advanced case management tools and by prioritizing higher value networks and conducting more efficient and accurate investigations. Capture all claims settlement amounts within the system to reuse with similar claims in the future.
    Gain a consolidated view of fraud risk.
    Identify cross-brand/product fraud by seeing customer claims and policies for all lines of business. Continuously improve models and adapt the system as needed to address changes in fraud trends. Understand new claim threats and prevent substantial losses early using social network diagrams and sophisticated data mining techniques.

    Gain a greater competitive advantage.
    Generate fewer false positives to gain greater satisfaction of legitimate customers. More diligent, effective fraud detection methods can actually discourage fraudsters from targeting your organization. And satisfy regulatory requirements by better managing fraud.




    Anomaly Detection.jpg Financial Crimes Monitor.jpg Fraud Alert Information.jpg Organized Fraud Schemes.jpg Social Network Analysis.jpg
     
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  3. bsdinsight

    bsdinsight Well-Known Member

    SAS Fraud Framework for Insurance2.png

    Data management
    • Consolidate historical data from internal and external sources – claims systems, watch lists, third parties, unstructured text, etc.
    • Eliminate or reduce redundant or inconsistent data with the solution's built-in data quality tools.
    • Seamlessly integrate the solution with your third-party applications.
    Rule and analytic model management
    • Create and logically manage business rules, analytic models, alerts and known bad lists.
    • Customize analytic models to identify potential improper payments not found by existing business rules.
    • Easily manage the deployment, aggregation, scheduling, suppression and routing of similar rules across multiple factors, such as parties, data sources and business lines.
    • Run groups of rules and models alone, in parallel or at different times (intraday, daily, weekly, monthly, etc.)
    Detection and alert generation
    • Calculate the propensity for aberrant billing at first submission, then rescore claims at each processing stage as new claims data is captured.
    • Review claims early in the adjudication process so you can stop suspicious activity at the prepayment stage.
    • Incorporate detection methods into the process at the most appropriate points – e.g., cases where anomaly detection scenarios may require data that isn’t available until later in the adjudication process.
    Alert management
    • Combine alerts from multiple monitoring systems, associate them with common individuals and gain a more complete perspective on the risk of particular individuals or groups.
    • Prioritize the reviewer’s order of alerts by scoring alerts in near-real time, based on the specific characteristics.
    • Route alerts to appropriate team members based on user-set rules and requirements.
    • View all evidence for each case via a dashboard that is customizable to your clinical, operational, or investigative unit's processes.
    Social network analysis
    • Go beyond transaction and account views to analyze related activities and relationships at a network dimension.
    • Identify linkages among seemingly unrelated claims using a unique network visualization interface.
    • Produce complete dossiers of networks surrounding a case and gain fast access to full details on all related parties and networks.
    • Produce independent and combined risk scores, so you can assess overall risk on a customer, claim or network basis.
    • Increase reviewer effectiveness by enabling, merging, and deleting network entities, and adding annotations (text/images) to specific entities in a network.
    • View how activity in a network develops over a time horizon, using time slider functionality.
    Optional integrated case management solution
    • Systematically pave the way for operational, clinical, or investigative reviews using a configurable workflow.
    • Store all information pertinent to a case, including detailed investigation information – e.g., interview or clinical notes and evidence for criminal or civil prosecution, restitution and collections.
    • Assess overall exposure, including losses due to improper payments as well as payment integrity issues detected or prevented.
    Analytic model-ready
    • Take advantage of prepackaged heuristic rules, anomaly detection and predictive models.
    • Adopt a health care-specific payment integrity data model.
    • Capitalize on the power of advanced analytics out of the box.
    Hosting and analytical services
    • Install and administer your solution at the SAS hosting site for faster implementation (and faster ROI) – while eliminating the need for payer staff to oversee the system.
    • Or host at your site, where SAS Professional Services staff will assist with the implementation and provide knowledge transfer.
     

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