Insurance Claims Fraud Prevention
01. The Challenge
B Because of decreasing budgets and increasing pressure from the overseer, health insurance companies need to take responsibility not only for the correct calculation of premiums but also for sufficient prevention and detection of improper claims. This increases the importance of information technology and data- and information analysis in order to obtain equal results. This is especially relevant for the reduction of damages, guarding the legitimacy and efficiency of care and to better predict the number of customers who will switch (every year) to another health insurance company.
This last topic especially has grown in importance during the last few years. Not in the least because many of the consumers who wish to switch only do so during the last few days of the year. By then it is often too late to respond in an appropriate way.
02. The Solution
Business Forensics provides software to timely detect, follow up end even prevent improper claims. Advanced algorithms and mechanisms have been developed to especially detect formerly unknown ways of claims and fraud risks. But just detection is not sufficient: advanced options to investigate and a structured way of collecting data are required to obtain sufficient insight to be able to adequately control and perform the correct analysis. Sufficient information on the context guarantee the required notion of the situation in this.
Proof of Concept
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