Claims Handling OPTIMIZATION and Fraud Detection For Insurance Companies in P&C, Life, Liability and Automotive

RiskShield intelligence claim evaluation software identifies legitimate claims automatically for fast track settlement and flags suspicious claims for further investigations.

Overview

RiskShield is a smart claim evaluation solution to optimize your claims handling process. As a supervised self-learning system, our decision engine automatically assesses the fraud risk of a reported insurance claim.

How does it work? An insurance claim automatically classified by RiskShield as inconspicuous can be settled faster and is more cost-effective, thus strengthening customer loyalty. The solution incorporates proven technologies such as fuzzy logic, pattern recognition, dynamic profiles and also supports external lists and databases to score claims quickly and effectively. Business rules can be enhanced and developed in real-time as new fraud patterns emerge, without any IT coding or system downtime.

Contact

Sandra Bleck

Sandra Bleck
Consultant
Tel: +49 (0) 2408 / 9456 - 5000 s.bleck@informinform-software.com

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Features

  • Intelligent Claim Assessment

    Enable supervised self-learning risk assessments by utilizing a unique combination of advanced risk assessment technology such as pattern recognition, customer profiling and fuzzy logic.

  • Workflow Automation

    Reduce handling costs by optimizing the routing process to the operations unit at the highest level of efficiency.

  • Advanced Analytics

    Unleash the value of advanced analytics to understand the costs of risks by using predictive modeling, simulations and data visualization tools.

  • Case Investigation

    Streamline alerts and case investigations with an integrated case management tool to manage your information in any form, from any source, all in one single environment.

  • Social Network Visualization

    Find hidden connections and relationships in a highly intuitive manner with RiskShield's interactive and graphical social network analysis tool.

  • External resources

    Connect to external resources such as credit ratings, crime record databases and other related information to further improve your claims assessments scoring.

  • Open and Transparent

    Easy to understand and user-friendly decision algorithms that can quickly adapt to a new modus operandi of fraudsters.

  • Proven technology

    More than 25 insurers across the world gain benefits from using RiskShield to optimize their claims handling process and fraud detection.

  • Seamless integration

    Open and highly configurable interfaces to easily integrate into the existing claims handling environment without impacting the IT systems.

Fast Track Settlement

Fast Track Settlement

RiskShield Fast Track Settlement approach is designed to identify claims which have a low risk and can be settled immediately with the claimant. Our objective is to risk score these claims in an efficient manner to increase customer satisfaction and lower the costs of claims handling.


RiskShield’s innovative risk scoring technique accelerates the claim settlement process and reduces the transaction costs. Here’s how it works:

  • Claim information is matched with customer profile, previous claims and external resources by using advanced analytics.
  • Within milliseconds an overall risk score is calculated and provided with clear instructions to the claim handler.
  • Claims which are likely to be fraudulent are forwarded directly for further investigation while legitimate claims are settled quickly and effectively.

    Social Network Visualization

    Social Network Visualization

    RiskShield Social Network Visualization offers fraud experts a natural way to discover hidden social connections and networks in their insurance claims portfolio. It allows insurers to visually interact with data and analyze alerts and claims to find any social links such as addresses, phone numbers, vehicle identification numbers and much more. Social Network Visualization is integrated with RiskShield Automated Link Detection to alert investigators automatically of any unusual relationship between policy owners, claimants and third-parties. Social Network Visualization provides you:

    • Graphical visualization to interact with your data and reveal hidden networks.
    • Support of multiple graphical data interfaces such as Network diagrams, Sociomatrixes and Chord diagrams.
    • Investigation of suspicious claims triggered by RiskShield Automatic Network Detection tool.
    • Fully embedded in RiskShield Investigation and Alert Management environment.

      Automated Link Detection

      Automated Link Detection

      Finding hidden relationships is searching for a needle in a haystack. With tons of data, it is almost impossible for insurance companies to find links between suspicious relationships or organized fraud rings. RiskShield Automated Link Detection exposes fraudulent networks by identifying and linking similar shared indicators between people, addresses and objects automatically. So how does this work?  Whenever a new claim is submitted RiskShield will automatically identify when there is a shared indicator, for example a known phone number or address with any previous submitted claim. If there is an unusual match RiskShield will alert the fraud expert to further investigate the relationship. With RiskShield Automated Link Detection, insurers can:

      • Automatically reveal previously unknown relationships to uncover fraudulent claims.
      • Connect the dots between shared indictors and parties which did not exist before.
      • Perform deep analysis with RiskShield's integrated Social Network Visualization.

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