Objectives

  • Identify actual frauds
  • Predict future fraud
  • Optimize claim processing

Actions

  • For each quotation and each claim, assess the risk of fraud
  • Prioritize and optimize claim processing thanks to a platform that centralizes all information

Predictive scoring

Each claim is qualified by cross-referencing:

  • consistency across quotations
  • expenditure history
  • customer profile
  • Our open data.

Insurance fraud is a major threat to the profitability and competitiveness of insurance companies and mutual health insurance companies. In these difficult times, these phenomena are increasing and can come from private customers as well as health professionals. Our DataFraud module is designed to identify any fraudulent patterns at an early stage in order to act swiftly and prevent the amounts of money concerned from increasing.

In addition, the analysis of quotations, prescriptions and reimbursement claims means that in 30% of cases, the fraud is identified before any payment is made by the company.

The estimated cost of insurance frauds is €8 to €12 billion per year.