Preventing fraudulent claims

Systematic fraud detection with adesso

Implementation of a successful strategy

Defending against fraudulent insurance claims is not only a legal obligation for insurance companies, but also an enormous lever for the effective reduction of loss expenses. The average claim for a fraud case, for example, amounts to approximately €6,500 in motor vehicle liability damages.

The establishment of a software-supported fraud detection solution can be a first milestone in the implementation of a successful strategy to prevent fraudulent claims. The keyword is ‘can’ because software does not immediately generate savings. These are realised in the second step through optimised control and by selecting the right cases for further processing, i.e. with professional investigative work and excellent service provider management.

adesso’s own fraud detection solution – a|advanced fraud management (AFM) – has a high-performance expert system that enables the automated evaluation of claims and is available as both an on-site and cloud-based service. Due to the distinctive interface capability, it is possible to connect it to and integrate it into almost every system or service. A downstream expert system also supports the further processing of suspected fraud cases.

In order for fraud cases to be optimally handled, adesso offers the following solution approaches:

  • Analysis of the current situation in fraud prevention/claim organisation
  • Examination or development of a reporting system for measuring success
  • Fraud prevention benchmarking in relation to the market
  • Open and closed file reviews to check the professional quality of fraud prevention and the skills of the employees in place for this purpose (raising awareness and qualification)
  • Evaluation of service provider networks (for example, external regulators, detective agencies and special experts)
  • Examination and analysis of legal defence by considering the solicitors used, the procedural approach and the litigation quotas
  • Support in the selection and introduction of fraud detection solutions

  • Implementation of an Interaction Room workshop on identifying problems and working out approaches to optimise the existing fraud prevention and claims organisation (for example, increasing the detection rate) – including a roadmap sketch for their implementation

  • adesso’s own fraud detection solution a|advanced fraud management (AFM)
  • Comprehensive support for the introduction of our fraud detection software into your existing IT landscape (independent of manufacturer) – including technical and functional design (architecture)
  • Development of individual fraud detection solutions (rule or AI-based)

What we can offer you

adesso is your partner when it comes to implementing a successful fraud prevention strategy, optimising existing processes and systems or selecting and introducing fraud detection software.

Do you have any questions?

Contact
Alexander Janoske

We would be delighted to talk to you.

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