Insurance fraud detection, investigation and mitigation solutions
Fraud costs the insurance industry upwards of $300 billion annually. In the long-term care (LTC) sector alone, estimates suggest that around 5% of claims involve some type of fraud. With benefits projected to increase to $40 billion by 2042, the LTC insurance industry stands to lose up to $2 billion over the next 20 years as a result.
That’s why we have proven solutions in place that protect our customers and their financial assets from LTC insurance-related fraud, waste, and abuse (FWA). Our industry expertise and fraud detection capabilities have saved carriers—including those with data from outside of our illumifin systems—millions of dollars over the last 5 years.
Fraud Sentry
As the largest claims payer in the LTC industry, illumifin developed Fraud Sentry in response to the mounting pressure facing LTC insurers in combatting FWA. Fraud Sentry automates fraud detection and surfaces FWA throughout the claims cycle, and our team also provides turnkey support like fraud investigations, fraud awareness training, and other fraud mitigation services to insurers.
This successful approach is driven by advanced analytics, visualizations, and machine learning, paired with cross-industry data—so our powerful detection capabilities reach far beyond what is currently possible with only human detection and manual, red flag-based processes. As a result, insurance companies save time spent on cumbersome research and can cost-effectively mitigate the expenses associated with FWA.
Fraud Sentry continues to deliver accurate results with the majority of referrals advancing to investigations, yielding multi million dollar savings to our insurance company clients.
Risk scoring
Each claim is assigned a risk score based on available data, which, along with comparisons, are easily viewed and sorted through a dashboard. And because risk evolves throughout the claims cycle—requiring different tools and methods to prevent ongoing fraud—we adapt our analytical approaches as claims mature to capture fraud incidents at all stages of the claims process.
Red flag alert system
When high-risk scenarios or “red flags” arise, our alert system proactively notifies fraud mitigation teams when and where potential fraud is occurring, empowering carriers with early identification to manage these events in real-time.
Network analysis
We also employ advanced network analysis to map the location of entities and individuals associated with a claim in relation to one another. This, along with industry network mapping capabilities, gives carriers visibility into potential organized fraud schemes and fraudulent networks.
End-to-end fraud mitigation services
Detection
Our insurance fraud solutions attack from all angles, surfacing even minute insights through our proprietary Fraud Sentry analytics program. We also offer enhanced training to carriers interested in hands-on identification.
Investigation
illumifin specialists can support all or part of the investigation, including initial research of the case file and open-source investigation, investigative plan design, and field investigation, including surveillance.
Conclusion
Once a case has been thoroughly researched and investigated, our specialists consult with each client to determine and execute the best course of action.
Get in touch
If you’re interested to hear more about illumifin’s insurance fraud solutions and our proven success helping protect insurers and their policyholders, reach out to learn more about Fraud Sentry.
