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Insurance

Insurance fraud costs insurance carriers and customers $80 billion annually in the U.S alone. Because most fraudulent claims are submitted by well organized fraud rings, early detection and investigation of these rings is vital to minimize financial losses. The challenge lies in uncovering the connections between the parties involved, their property and the insurance providers.

i2 solutions help you discover patterns of fraud by enabling you to access and integrate volumes of data into your analysis . During an investigation, i2 products enable you to:

• Easily integrate claims, policy, billing, public records and financial data
• Develop the case through data exploration and visualization
• Discover and visualize the sequence of events, frequency of behavior, and flow of commodities
• Effectively present complex information to your management, corporate attorneys, and law enforcement
• More swiftly end fraud exposure to minimize financial losses

The first step in developing your analysis is to access the right data. i2 products enable you to access and integrate your data from different sources. iBridge can provide live connections to your Claims, Policy and Medical Billing databases, ensuring you work with the most current information.

iBase captures, stores and organizes data from one or more sources in a central location. It can be populated quickly with vast amounts of multi-format data gathered during an investigation, offering full query and reporting features. With help from iBase, analysts and investigators can discover new medical providers, patterns of improper medical billing and patient brokering.

Additionally, it is easy to overlook important details and lose track of key connections hidden across multiple documents. With TextChart, you can extract vital case information and present the data in an intuitive visual format. TextChart enables you to tap all available data sources including examinations under oath and deposition transcripts, outsourced investigation or surveillance notes, hard copy bills and receipts for claims, medical records and legal provider records.

Once data are extracted, they can be combined for proactive and reactive analysis using iBase and Analyst's Notebook.

With Analyst's Notebook you can discover and visually depict relationships between insured parties, claimant parties and legal, medical and property providers.

Investigators can use timeline charts like this to identify the precise sequence of events in a case.

Using iBase and Analyst's Notebook, you can discover patterns and trends and isolate previously unknown relationships. Having a clear depiction of key players, relationships, and activities can help to maximize investigative resources. And relationships discovered as you add information may strengthen a case or lead to previously undiscovered fraudulent claims.

For instance, you can visualize medical providers by clinic or focus on individual elements of your investigation using drill down tools, scored matching and other analytical features. You can discover, for example, that:

• The insured driver in one claim lives at the same address as the claimant passenger in another
• Individuals involved in multiple claims repeatedly use the same medical and legal providers
• Insured drivers and claimants involved in multiple claims purchased policies from the same agent
• A medical provider bills the same treatment for multiple patients regardless of injury

i2 products can be used to organize and analyze thousands of case related transactions. Collaborate as a team and present your findings to claims management, corporate attorneys and investigators in an intuitive chart.

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With the right analytical methods and tools, insurance professionals can effectively uncover, investigate and prosecute ever-changing fraud activity. See for yourself why our essential analysis tools are the industry standard for more than 2,000 organizations worldwide.

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