First fraud detection system that scores at the claim-line level during claims processing
NEEDHAM, Mass. – September 14, 2015 – Enservio, Inc. today introduced ContentsAnalyzer™, the industry’s first and only fraud detection solution that identifies and scores fraudulent claim items at the individual line item level in real-time as claims are processed. Available as a monthly service subscription, ContentsAnalyzer targets soft or opportunistic fraud for home contents claims relating exclusively to theft. The anti-fraud tool will eventually support modules to detect fraudulent insurance claims as it pertains to other perils such as fire and water/floods.
Until now, fraud tools have been incapable of flagging claimed items with values that exceed market benchmarks. For example, a $50 coffee maker claimed at an inflated value of $500, would not have been flagged in the past. ContentsAnalyzer can flag this type of soft fraud, comparing and contrasting pricing data for signs of exaggerated or padded claim values that may point to opportunistic fraud.
ContentsAnalyzer examines the claim line items and their data outliers, determining the standard contents makeup of a residence of a given size, in a given zip code, and even drilling down to a specific neighborhood block. It compares the value of a line item with the average retail value and the replacement cost value of the same item with the same brand and age.
Alerts are generated when the system compares the claimed items against pricing norms, historical, geographic and demographic data, comparing and contrasting this data to identify anomalies. If the value of a claimed item appears to be inflated or fabricated, the SIU receives an alert. For example, if a policyholder submits a claim for a riding lawn mower but lives in a small apartment with no garage, the SIU receives an alert.
ContentsAnalyzer Features & Benefits
- Identifies soft fraud not detected by existing solutions
- Catches fraud before settlement, saving insurers millions in fraud costs
- Compares the value of each claim line item against external data points, such as average retail cost and replacement cost values
- Examines claim line detail for pricing irregularities, flagging padded claims and opportunistic fraud
- Scores in real time and analyzes the claim continuously throughout its lifecycle
- Integrates with existing fraud detection and custom solutions
- Does not require extensive user training or IT support
- Upwardly scalable, able to handle vast volumes of data feeds
More information on ContentsAnalyzer fraud detection solution can be found at: http://www.enservio.com/products-services/contentsanalyzer