Stay ahead of the competition with a unique fraud prevention solution. Photo by Medius.

If your insurance company deals with many claims, investigators can only investigate and uncover a certain number of potential frauds. The criterion relies heavily on past behavior and experience of fraud investigators and senior experts in detecting fraud. But fraudsters are always looking for new ways.

Large amounts of data can therefore be a challenge or an opportunity.

Medius Fraud Detection Solution enables:

• Instant claims scoring
• Real-time decision making
• Claims automation
• Faster payment of non-fraudulent claims
• Lower claim payout due to improved fraud detection

Problems we are solving

It is almost impossible to check all claims manually. Automating this process by evaluating claims against a predefined model and static rules makes a tremendous difference. Claims below a predefined threshold can be paid out immediately. Only claims above the threshold need to be reviewed by an individual. But the real progress is achieved when machine learning (ML) is included in the equation.

The crucial question is how to detect the damage claims with a reasonable suspicion of fraud. A damage claim has many parameters, but an average person can remember a maximum of 5 when comparing different damage claims, and even then, the results from that comparison are not immediately available for processing.

On the other hand, the computer can remember incomprehensibly more parameters, while also simultaneously comparing, sorting, and processing the claims. It is not surprising that a computer fraud detection system is much better prepared for handling large amounts of data than a human being. If we add ML, the system becomes additionally equipped for detection of new frauds that are not yet recognized or known to investigators.

Options and Benefits

Options offered by us:

• ML as a sandbox in which investigators can create new models, attributes, and simulations with powerful visualization.
  → Benefit: more accurate fraud detection.
• ML as a tool for determining the relevance of predefined scoring rules and claims, which helps fraud investigators determine the relevance and thresholds of rules and claims. Claims below the threshold can be paid out immediately.
  → Benefits: reduced resource usage, faster time to resolution, improved customer experience.
• Automated Fraud Detection System that evaluates which cases are more likely to be fraudulent with a high probability of over 80%.
  → Benefit: improved efficiency and accuracy.
• Custom Options. There are several options available for using this solution. We are open to discussing a specific case that is relevant for your insurance company.
  → Advantage: stay ahead of the competition with a unique fraud prevention solution.

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