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
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
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
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.
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
Improved expense ratios. Faster and accurate claim decisions
reduce claims float;
Fraud knowledge retention. Mitigates risk of human knowledge
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
Higher degree of accuracy. An industry-leading text analytics
engine enables a scoring approach that significantly reduces
false positives and negatives.