SAS^® Fraud Decisioning for Claims

SAS Fraud Decisioning for Claims Features List

Data management

Includes an insurance-specific claims fraud data model.
Consolidates historical internal and external source data from claims systems, watch lists, third parties, unstructured text sources and more.
Eliminates or reduces redundant and inconsistent data.
Integrates with existing third-party systems seamlessly.

Advanced analytics with embedded AI & machine learning

Provides a broad set of modern statistical, machine learning, deep learning and text analytics algorithms in a single environment, such as clustering, regression, random forest, gradient boosting, support vector machine, natural language processing, topic detection and other methods.
Allows simultaneous fraud model tests and comparisons of multiple supervised learning algorithm results with standardized tests.
Continuously updates and improves models based on prior results.
Enables responsible AI with embedded model interpretability, fairness and bias monitoring.

Rule & analytic model management

Streamlines deployment, aggregation, scheduling, suppression and routing of simple or complex rules across multiple factors, such as parties, data sources and business lines.
Lets you run groups of rules and models alone, in parallel or at different times (real-time, intraday, daily, weekly, monthly, etc.).
Facilitates collaboration on model development across the organization.

Detection & alert generation

Scores claims for fraud at first submission then rescores them at each processing stage as new claims data is captured.
Reviews claims early in the adjudication process to help stop suspicious activity at the prepayment stage.
Allows you to incorporate fraud detection at the most appropriate claims processing points; for example, where anomaly detection scenarios may require data unavailable until the adjudication process.

Alert management

Combines and associates alerts from multiple monitoring systems with individuals to provide a more complete perspective on an individual’s or group’s risk.
Prioritizes the investigative order of alerts through real-time scoring based on specific characteristics.
Automatically routes alerts for investigation based on user-defined rules and requirements.
Displays all evidence for each case on a dashboard customizable to your investigative unit's processes.

Social network analysis

Goes beyond transaction and detailed claims view to show the network of related activities and relationships, and identify linkages among seemingly unrelated claims.
Produces complete network dossiers surrounding a case with full details on all related parties and networks.
Calculates independent and combined fraud scores, highlighting overall customer, claim or network risk.
Increases investigator effectiveness by enabling investigators to merge and delete network entities and add annotations (text and images) to specific network entities.
Shows how network activity develops over time with time slider functionality.

Search & discovery

Enables free-text, field-based or geospatial searches across all internal and external claims data.
Lets you refine searches using interactive filters and facets customized for claims and SIU teams.
Provides full entity descriptions that include other linked entities, for a more detailed evaluation of the likelihood of fraud.
Provides an intuitive interface that lets you construct complex queries without the need to understand specific syntax. For example, you can use fuzzy searching, proximity searching and field boosting while restricting searches to specific entity types, fields, comments or insights.

Case & intelligence management

Systematically facilitates investigations using a configurable workflow.
Stores all pertinent case information, including detailed investigation information, such as interview notes and evidence for criminal or civil prosecution, restitution and collections.
Assesses overall fraud exposure, including losses due to fraud as well as fraud detected or prevented.

Flexible deployment options

Offers the advantage of cloud-native analytics, designed to run on major cloud providers.
Supports data and analytics workloads in on-premises or private, public and hybrid cloud infrastructures.
Removes the barriers to adoption when hosted in the SAS Cloud or remotely managed by SAS.
Ensures you’re up and running quickly, delivering speed-to-value.
Integrates with your existing operations, workflow solution and business process management objectives, including thorough business process discovery and review to ensure your objectives are met.