4. RA7 solution - overview
• 1 integrated solution
• 1 day agent’s or 5 days front line
investigator training!
• 100 % calls coverage
• Streamline & standardize
investigation procedures
• Unbiased. Informing. Precise.
5. RA7 solution
RA7 can be used for:
• Claim processing
• Underwriting & Risk assessment
• Loan requests & credit cards
• Periodic “over-the-phone” tests
6. RA7 solution - Limitations
•Not all fraud will be detected.
•Not all cases will be proved.
•Not all customers will be
happy.
… but most of the time it will.
9. (1) To have a significant effect
on your bottom line.
(2) To improve customer
service
(3) To change as little as
possible current procedures
RA7 – Our mission:
10. RA7 – Our mission:
• Using RA7 solution we will achieve the following:
• Monitor all incoming claim calls for fraud attempts
increase overall Fraud Detection Rate
• Add 2nd
level of customer handling
“Assist” fraudsters withdraw their claims
• Provide a faster payout for claims that are risk-free
Faster and better service for legitimate customers
• Customer awareness to the “Risk” taken when trying to commit fraud
reduce number of fraudulent claims
11. RA7 solution – One System
• The contact center – Today:
• No procedure for risk assessment, no point in training
• The only place in touch with 100% of the calls
• Claim Managers / Loss adjustors
• Oversees all cases, must reach decisions fast
• Lacking tools to really detect fraud –tools are biased by definition
• Investigators
• Limited and expensive resources
• Poor start point with little useful data
• Have to filter through high % of genuine claims
13. Streamlined process
• 100% of the calls are monitored and analyzed
• Operators follow a special “conversation script”
• RA7 automatically determines RISK LEVEL for each of the calls
• Trained operators can detect and deter fraud at the initial
interaction
14. Streamlined process
• Claim managers / Loss adjustors receive clear reports of all claims
• Easily manage and assign high-risk cases to investigation
• Can conduct a follow-up interview or authorize the payment
15. Streamlined process
• Handle only high risk claims – better chance for defeat
• Save time on the field - conduct more phone investigations
• Can use other professional tools by Nemesysco
16. Fraud awareness,
a real necessity…
A survey conducted in Pennsylvania in 2008 revealed the following:
1. Knowledge about insurance fraud itself is minimal. Only one in six respondents was
knowledgeable about how insurance fraud is classified and defined. Even fewer
understand that insurance fraud is a felony.
2. Many do not believe insurance fraud is a serious crime. Only 12% categorized
insurance fraud as one of the most serious types of crimes and only 25% said they
were likely to report someone who was committing it.
3. Nearly 70% stated strongly they would never consider committing insurance fraud.
But, this leaves 30% who might consider committing the crime.
4. Almost all surveyed believe that insurance fraud perpetrators rarely get caught. An
extremely low number (3%) reported “strongly believing” those who commit
insurance fraud will be discovered and apprehended.
17. RA7 project process
• Adopting the new concept & technology
• The “fraud prevention stick” and “Fast track carrot”
• Becoming proactive in fraud detection
• P.R. and Legal concerns
• Creating scripts
• Understand in-house investigators needs
• Covering all types of relevant claims
• Implementing RA7
• IT and installation
• Training & Mentoring
• Follow-up and support
