Predictive analytics solution for claims fraud detection - Gain better control over fraudulent claims

1. Predictive Analytics Solution
for Claims Fraud Detection
Gain better control over fraudulent claims

2. Many insurance companies today, are using
predictive analytics solutions for detection of
fraudulent claims. These solutions require defining
and designing analytical models and then feed
data into them for analysis. As this analysis is
based on a set pre-defined model, it may fail to
yield desired results in achieving the claims fraud
detection objective.
Thus advanced claims analytics is an urgent need
in the industry to prevent claim leakages and
improve loss ratios. Insurers need to have an ability
to analyse vast amount of historical data in a
speedier manner and integrate fraud management
in this discovery process at an early stage. This will
have a far reaching impact not only on the claims
processing but also on product design and pricing.
Introduction

3. Industry average shows that historical fraud detection methods
only uncover about 10% of losses, and because of the 'Pay-and-
Chase' recovery process, less than 5% of losses detected are ever
recovered. Problem is there are multitude of ways fraudulent
claims can be filed, however it's humanly impossible to foresee
and build all the possible scenarios to detect frauds.
Thus advanced claims analytics is an urgent need in the industry
to prevent claim leakages and improve the loss ratios.
Solution Brief
Zensar’s Predictive Analytics solution for fraud
management comes with an ability to provide hypothesis-
free automated analysis and deep insight for business
through advanced analytical models. It leverages the
existing fraud management experience and industry
fraud-detection techniques to increase the probability of
fraud detection.
The key outcomes of the solution are
Granular analysis of the data
Identification of potential fraudulent claims early in the
claims process
Actionable data to business that can be fed to claim
adjudication system
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Predictive Analytics
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Extract Data from
source system
using ETL
Extract Data from
heterogenous
source
Data
completeness
Row count
validations
Extract Data in
excel files to load
into analytics
platforms
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Business rule
validations
Data accuracy
Data quality
Data
transformation as
per target data
model
Data reconciliation
Extract Transform LoadSource Systems
OLAP Databases
(Claim, PAS) Customer Data
Data Warehouse
Data Mart Flat Files
Predictive Analytics Platform
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Process Data
Analyse Data
Flag data
Export actionable data
Claim Management
Claim
Initiation
Claim
Assessment
Fraud
Management
Claim Payment
and Closure

4. For more information please contact:
marcom@zensar.com | www.zensar.com
Zensar Technologies
Zensar is a leading software and infrastructure services and solutions provider with industry expertise across
Manufacturing, Retail, Insurance, Utilities, Banking, Financial Services and Government. The company delivers
comprehensive services for mission-critical applications, enterprise applications, business intelligence and analytics,
testing, business process management, e-commerce and digital enterprise services. Using its multi-shore capabilities,
Zensar combines expert consulting, integration and support services with world-class customer service to help
organisations attain significant business outcomes. Zensar has 8000+ associates with operations across US, Mexico, UK,
Europe, Middle East, Africa, India and Asia Pacific.
Corporate Headquarters: Pune, India
Global Offices: USA | UK | Europe | Africa |
Middle East | China | Singapore | Australia
Key Features
Offered as Platform as a Service model that does not
require upfront capital investment
Plug and Play solution
Ability to process large volume of historical data within
few minuts using complex algorithms and seamlessly
add more variables to analysis
Ability to improve fraud detection effectiveness based
on insights obtained through analysis at pre-defined
frequencies
Easily integrate data with business application like
claims
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Business Benefits
Proactive ‘Predict and Act’ approach against the
reactive ‘Pay and Pursue’ approach resulting into
reduction in claims leakage, subrogation recoveries
and improved loss ratios
Ability to continuously evolve the fraud management
process to improve performance of claims processing
Increased efficiency and accuracy of the claims process
resulting into improved customer satisfaction
Effective, faster and reliable fraud detection and
subsequent prevention process
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