Claims Fraud Alerts & Case Management (Xebia’s Insurance Suite)

Overview

"Fraud Alerts and Case Management" is one of the many applications offered as part of Xebia’s Connected Claims Insurance Suite. Each of the provided applications in the suite can be deployed independently or in combination with other applications as per the business requirements.

Insurers often lose billions of revenue in settling claims that are fraudulent. Hence this is a critical area in claims processing that needs transparency, clarity and a unified view of all data points. With multiple entities and objects associated with each claim such as third-parties, third-parties vehicles, contacts, addresses and past claims it is challenging to see how each of the given entities are related. Having this visibility of how entities are involved in prior reported claims would be helpful in the entire fraud investigation case management. This functionality among others is where Xebia's Fraud Alerts and Case Management can help. * Ability to bring in data and fraud connections from any of your existing fraud detection systems.

Key Features & Functionality

  • Ability to bring in data and fraud connections from any of your existing fraud detection systems.
  • Configure fraud alert checklists and their corresponding scores based on which system calculates the net alert score and generates an alert if that crosses the threshold alert score. Fraud alerts review team scans the generated alerts to see if there is a need to have an SIU case initiated on a claim.
  • Powerful fraud ring visualization graph is available directly on alerts dashboards both for the investigation team and the SIU to help identify if a claim is a fraud or not.
  • Investigators and SIU officers can annotate any nodes (vehicle, case, claim, any other object) of the fraud graph with comments. Therefore, all of the notes and documents are available for future reference when the same node becomes the part of the fraud ring in any future claims, bringing high value in fraud case management.
  • SIU and other internal users can collaborate on real-time on the generated alert on a given claim requesting any additional information to expedite the investigation process.
  • Dedicated and rich record dashboard for alerts and SIU cases with each alert linked to the corresponding claim and are available on claim record to view to see the possible chances of a given claim being a fraud for a claim adjuster.
  • Every SIU case has self-configurable workflows such as Investigate Case, Manager Review and Legal Manager Review.
  • Configure approval cycles for investigation review case management, with the output of either marking a given claim as fraud or passed. This accelerator follows standard insurance practices and is easy to integrate with any Appian application.

Xebia's Connected Claims Insurance Suite of apps offers a complete claims management solution built on Appian. The suite has the following applications:

  1. Claims FNoL
  2. Claims Fraud Alerts & Case Management
  3. Claims Operations & Settlement
  4. Claims Subrogation & Litigation
  5. Field Inspections
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