Insurance fraud detection, investigation and mitigation solutions
Fraud is a massive problem in the insurance industry. In the long-term care (LTC) sector alone, cross-industry estimates suggest that 3-10% of the $12 billion paid in claims last year was lost due to fraud, waste, and abuse.
As the largest claims payer in the LTC industry, we developed Fraud Sentry to automate fraud detection and surface fraud, waste and abuse throughout the claims cycle with advanced technology. We also provide turnkey support with fraud investigations, fraud awareness training, and other fraud mitigation services to support the carriers we work with.
Fraud Sentry
At illumifin, we designed Fraud Sentry to help long-term care insurers combat fraud, waste, and abuse. The software leverages advanced analytics, visualizations, and machine learning, paired with cross-industry data. Insurance companies and policyholders are protected from costly fraud, waste, and abuse through its powerful detection capabilities, far beyond what is currently possible with human- and red flag-based systems.
Risk scoring
Fraud Sentry assigns risk scores to claims based on available data. Risk scores and comparisons are easily viewed and sorted through the dashboard.
Red flag alert system
Fraud Sentry insurance fraud detection software provides an alert system that notifies fraud mitigation teams of high-risk scenarios and red flags as they occur, allowing carriers to manage these risks in real-time. This highly visible warning alerts users when and where potential fraud is happening.
Network analysis
Via advanced network analysis, Fraud Sentry maps the location of entities and individuals associated with a claim in relation to one another, allowing illumifin to see potential networks colluding to defraud policyholders and carriers via organized fraud schemes. Fraud Sentry supports industry network mapping, providing the capability to spot organized fraud affecting numerous carriers and policyholders, helping to identify fraudulent networks and organized crime plaguing the industry.
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 and with enhanced training for carriers for hands-on identification.
Investigation
illumifin specialists can support part or all of the investigation: initial research of the case file and open-source investigation, investigative plan design, and field investigation.
Conclusion
Once a case has been thoroughly researched and investigated, illumifin specialists consult with customers to determine and execute the best course of action.
Fraud Sentry
Fraud detection automation throughout the claim cycle
Risk evolves throughout the cycle, requiring different tools and approaches to prevent ongoing fraud. Fraud Sentry changes analytical approaches as claims mature to capture fraud incidents at all stages.
Get in touch
Want to learn more about how illumifin’s insurance fraud solutions with Fraud Sentry can help your company mitigate long-term care insurance fraud?
