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Frequently Asked Questions
Who is LexisNexis?
LexisNexis® is a leading provider of information and business solutions to professionals in a variety of industries-legal, risk management, corporate, government, law enforcement, accounting, and academic. A member of Reed Elsevier PLC, the company does business with professionals in 100 countries with 13,000 employees worldwide.
The LexisNexis Risk & Information Analytics Group delivers actionable intelligence to help clients make critical business decisions with confidence and speed. Building on the 30-year LexisNexis tradition as a trusted provider and custodian of quality information, we leverage cutting-edge technology, unique data, and advanced scoring analytics to provide total solutions for client needs.
Our solutions are designed to serve the multi-billion dollar risk information industry, which includes professionals and organizations such as law enforcement, government agencies, financial services firms, collection agencies, insurance and health care providers, hiring managers, and others.
What Claims Solutions products and services do you offer?
LexisNexis Claims Solutions integrates data, analytics and services to improve claims outcomes. As such, we have several different products and services available to help your company improve its claims outcomes. Please visit the Products section of this Web site for more specific information on each of our available products and services.
How do I purchase or learn more about a Claims Solutions product?
To purchase or learn more about one of our products, please call 1-800-934-9698, option 5.
How do I know I have enough data to build a good model?
That’s one of the most common questions we get. For the custom model, the range of data varies from carrier to carrier, but is often quite large. However, the quantity of data certainly has a bearing on how powerful the model is. We have not yet worked with a carrier who didn’t have sufficient data to build a workable model that produced a marked improvement in the claims process. In addition, we’ve done work on standard industry formats where data might readily be available in a carrier format. It’s possible to leverage those existing data formats in a way that’s useful and much quicker to implement for those carriers who want to go that route.
How does Fraud Focus fit into my existing SIU referral program?
FraudFocus can supplement in a couple of different ways. Some carriers pass the results of FraudFocus, or the indications that claims are ones that the SIU might want to pay attention to, to their adjusters for potential referrals. That’s probably the most common case, so it is important to help adjusters understand how to use these scores for business rules hits. In addition, some carriers supplement the results of FraudFocus with triage at the SIU level by having trained SIU investigators look at very high scoring claims. From there, the adjusters can either make an auto-referral to the SIU or counsel with claims adjusters to encourage them make that referral. Either way, FraudFocus can supplement the existing process of those claims adjusters who are making good referrals today.
Do I have to use all of the FraudFocus components at once?
No, they don’t all have to be used at once. We think that the core tools that are appropriate for starting this process would be the predictive model, the business rules and the identity match—those core analytic tools that help create a target-rich environment of claims for your investigative resources. Additional tools such as case management and link analysis are very valuable, but can be added on to the core system. Once the datamart is created for a custom FraudFocus, adding on these additional tools over time--and any additional tools that are developed--is relatively straightforward.
How many carriers have you worked with on the Claims Predictive Modeling Programs? Can you share some of their names?
We have four carriers with FraudFocus custom systems operational and we are in the process of installing others. So, there are carriers that we can refer interested parties to who can talk about their experience. Please contact us form more information and we can refer you to one of these carriers.
How many different lines of insurance have you built models for?
We have built models for automobile, both personal and commercial, for property, for worker’s compensation, for general liability, for special assigned risk pools. These kinds of techniques actually work where there is data and identified past history of fraudulent practices, so we have worked in many lines.
Are there "generic" models that I can use right now vs. having to build "custom ones"?
If you’re in the state of Massachusetts. We’ve worked with some carriers in that state to build a model that can score claims data in the CAR format in Massachusetts, but that’s the only one that we’re aware of at the moment.
How can I contact a LexisNexis Claims Solutions representative?
Please call 1-800-934-9698, option 5 or send an e-mail to insurance.claims@lexisnexis.com. |
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