A claims fraud-detection system helps insurance carriers identify fraudulent claims, at both the individual and organizational levels. It is typically used by claims teams and in special investigative units (SIU). There are a variety of business benefits that can be achieved from claims fraud-detection solutions, but two of the primary goals are:
Improving the carrier’s loss ratio by identifying illegitimate claims.
Enhancing the overall customer experience by giving carriers the confidence to quickly indemnify claims that are deemed valid.