Fraud by numbers
(UK) Undetected general insurance claims fraud total £1.9billion a year adding on average £44 to the annual costs individual policyholders face, on average, each year.
(US) Fraud accounts for
19 percent of the $600 billion to $800 billion in waste in the U.S. healthcare system annually.
Risk Assessment- The RA7 solution
Fighting insurance and financial fraud more effectively
than ever before
The new RA7 solution is a combination of tools, investigation techniques and research results from the past 14 years. RA7 is designed to tackle most of the fraud attempts your organization is facing, with three objectives in mind:
- To significantly increase your bottom line by minimizing unrightfully paid claims
- To streamline and expedite the investigation procedures, saving time and money
- To improve your legitimate customers’ service and support at their time of need
We aim to achieve all these goals with minimal disruption to the process flow and policies currently in place in your organization.
RA7 is a “task-based” open architecture integrated solution that requires only 1 day of basic training. Once implemented, it is intended to analyze 100 % of the relevant calls, providing streamline & standardize procedures, right from the call center level.
The RA7 Agent post merges carefully designed conversation scripts together with the power of Nemesysco’s voice analysis technology, to lead the conversation step by step to its rightful closure. RA7 leaves minimal room for human error and creates automated digital or printed risk reports for the supervisors review.
RA7 Management posts display all the recent cases created by the Agents and their risk reports, to assist managers examination of the case details and help them reach an educated decision faster.
RA7 Investigators' posts tools are made to assist and speed your in-depth investigative processes, providing the investigator with precise information that can highlight problematic areas in the claimant’s story. The solution allows the investigator to focus on the problematic cases, and if these are indeed identified as High-Risk, to use other formal investigation techniques to counter the illegal fraudulent attempt.
RA7 process aims to classify claims into 3 categories:
- Low risk claims - Genuine claims, in which the material issues and material details are correct and are not exaggerated. These claims\requests will be forwarded to the “Fast Track” processing.
- Medium Risk Claims – In this type of claims, the material insurance case is correct, but is most likely suffering from some inaccurate or inflated details. These claims are forwarded to Loss Adjusting process using additional tools, in order to try and minimize the claim to its rightful size.
- High Risk claims – In these cases the basic insurance case is suspected and should be further investigated. Such claims will be forwarded to the Special Investigation Unit for a second interview.
"Fast Track" processing is an important part of the RA7 solution. By quickly releasing the majority of claims which are genuine, your rightfully deserved customers will receive a better service than would otherwise not be possible, and allow the allocation of more investigation resources where needed.
RA7 tools are not “Lie-Detectors”. The RA7 system was designed to offer a balanced approach between your customers’ rights to receive fair and quick service at their time of need, with any organization requirements for proper assessment and evaluation of relevant information.
RA7 solutions are designed for:
- Claim processing
- Underwriting & Risk assessment
- Loan requests & credit cards
- Periodic “over-the-phone” status verification
RA7 – Unbiased. Informing. Precise.
For more information, please contact us: bizdev@nemesysco.com