TCS Insurance Fraud Analytics Solution

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TCS Insurance Fraud Analytics Solution

  1. 1. Fraud Analytics Solution for Insurance Most insurance companies today find fraud in only one to three percent of the total claims processed – far less than the estimated fraud of ten per cent of all claims, as per the National Insurance Crime Bureau (NICB). A growing need to identify fraudulent claims drives insurance companies to look for effective solutions that assist in better claims analysis. Companies need to identify fraudulent claims accurately, and streamline claimsprocessingtoreduceclaimslossesandincreaseprofits. At Tata Consultancy Services (TCS), we help companies reduce loss with the Fraud Analytics Solution for Insurance, a human-intelligence based tool with a 360-degree view of claims. Our solution utilizes modern text analytics to tap into a broad source of data in a structured form, as well as unstructured data such as: claim notes, call center notes, medical reports, police reports, emails, and web-based content. Together, these help you capture fraudulent claims consistently while increasing the efficiency of the adjuster and minimizingtheuseoftheSpecialInvestigationUnit’s(SIU)resources. Overview Carriers seek effective analytical measures to identify fraudulent claims while reducing claims processing time. Companies need better assessment to ensure that suspicious claims, many which are otherwise missed by examiners, are referred for investigation. These enterprises require a complete package of analytics support. The Fraud Analytics Solution for Insurance, from TCS, is an enterprise-wide package that facilitates cost reduction, improves claim administration, increases customer satisfaction and fosters business knowledge retention across the company. Our solution seamlessly addresses your needs by tapping into a broad source of data that will give you a 360 degree view of claims. Fraud Analytics Solution for Insurance helps improve the efficiency of the adjuster and SIU resources with accurate fraud detection. Predictive modeling techniques identify new fraud characteristics and enhance the accuracy of fraud dictionaries. Our line of business-specific fraud dictionaries help fraud specialists quickly build and refine scoring models with weighted suspicion indicators. Claims are scored and subject to further investigation depending on the level of suspicion. Our self-service workbench aids fraud specialists, fraud analysts, examiners, adjusters, supervisors, and executive users in efficiently identifing frauds and tracking claims KPI. The Fraud Analytics Insurance Solution will help you make better decisions through enhanced analysis. While complex analytics and workflow take place in the background, clients appreciate the user-friendly workbench. Benefits Our solution improves margins through early detection of fraud and reduced fraudulent claims payout. You further benefit through: Improved loss ratios. Early detection of loss yields prevention and compromise opportunities; Improved expense ratios. Faster and accurate claim decisions reduce claims float; Fraud knowledge retention. Mitigates risk of human knowledge drain; Regulatory compliance. Identifies suspicious claims, that are not reported to state agencies through text analysis; Training opportunities. A focus on text uncovers inconsistent use of red flags across claim examiners and identifies training opportunities; Higher degree of accuracy. An industry-leading text analytics engine enables a scoring approach that significantly reduces false positives and negatives. n n n n n n Patent Pending
  2. 2. www.tcs.com All content / information present here is the exclusive property of Tata Consultancy Services Limited (TCS). The content / information contained here is correct at the time of publishing. No material from here may be copied, modified, reproduced, republished, uploaded, transmitted, posted or distributed in any form without prior written permission from TCS. Unauthorized use of the content / information appearing here may violate copyright, trademarkandotherapplicablelaws,andcouldresultincriminalorcivilpenalties. Copyright©2013TataConsultancyServicesLimited IT Services Business Solutions Outsourcing TCSDesignServicesM0313III Contact To know more about TCS Fraud Analytics Solution for Insurance, contact insurance.practice@tcs.com AboutTataConsultancyServices(TCS) www.tcs.com Tata Consultancy Services is an IT services, consulting and business solutions organization that delivers real results to global business, ensuring a level of certainty no other firm can match. TCS offers a consulting-led, integrated portfolio of IT and IT-enabled infrastructure, engineering and assurance services. This is delivered TM through its unique Global Network Delivery Model , recognized as the benchmark of excellence in software development. A part of the Tata Group, India’s largest industrial conglomerate, TCS has a global footprint and is listed on the National Stock Exchange and Bombay StockExchangeinIndia. For more information, visit us at Why TCS With more than three decades of insurance expertise and global operations that serve the top insurers around the world, we lead in providing state-of-art services to the industry. With significant successes delivered through proven processes, deep technology expertise, and strong domain knowledge, we have the track record and exceptional qualifications that leads insurers to select us as their partners. In addition, we bring to the solution our: Strong insurance domain capabilities. We have extensive experience in supporting insurance customers with our pool of professionals. Most of our associates have industry certifications and have undergone extensive industry training programs with LOMA, LIMRA, CPCU, etc. Global Network Delivery Model™. Our unique business model ensures the consistent delivery of high-quality, cost-effective services anywhere, at any time. Solution accelerators. We complement our offerings with our products, tools, and methodologies, which solve the challenges of IT and operations, and enable business leaders to quickly introduce higher quality products and services. Innovation Labs and Co-Innovation Network™. Our global solution centers, state-of-the-art innovation labs, and our research and development team combine into the Co-Innovation Network™, to drive and apply innovative, real-world solutions for insurers. n n n n An overview of Fraud Analytics Solution for Insurance Workbench Administration Workbench Scoring Workbench Analyst Workbench Executive Workbench Data Sources Database Text Sources Email Imaged Content Internet Content $$$ Fraud Identification Scoring Analysis & Workflow Reporting & Performance Management Data & Dictionaries Fused Claim record Predictive Modeling Text Analytics Suspicion Indicators Tier 1 Tier 2 Tier 3 Score

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