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FraudFocus
FraudFocus automates and standardizes the fraud detection process, providing a new level of consistency and efficiency in identifying likely fraud. By comparing insurance claims to historical fraudulent patterns, FraudFocus can identify the likelihood of fraud at the earliest possible moment.
FraudFocus:
- Reviews each claim, provider or policy for subtle fraudulent patterns using techniques more powerful than traditional red flags or rules alone.
- Reviews each claim and provides alerts when thresholds have been exceeded.
- Compares individuals and organizations to internal and third-party lists to flag matches of similar identities.
- Allows an investigator to search for links among claim data elements that may point to collusion or rings.
- Prioritizes and organizes claims so the most appropriate action can be taken through automated special investigative unit referrals, additional data look-ups and adjuster or specialist notification.
- Provides reporting, tracking and analysis tools to identify trends and optimize the fraud referral and mitigation process.
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