Complete fraud detection & fraud case management solution to help investigation & special investigation team unit with system proactively alerts for any potential frauds based on configurable risk scoring & dynamic fraud case management framework.
The claims process is prone to potential frauds where a claimant may try to trick the system to get the benefits or advantages which they are not entitled to get.
Each year insurance companies lose considerable money to such claims. To minimize the loss from such frauds, many insurance companies today have a specialized fraud system to check for potential frauds. However, in doing so, they have created data silos where the adjusters have to log in to multiple systems to settle the claims.
Claims Fraud Detection & Case Management is one of the many applications offered as part of Appcino's Insurance Claims Operation Suite. Each of the provided applications can be deployed independently or in combination with other applications as per the requirements & use cases. This application follows standard insurance practices and is easy to integrate with any Appian application OR external existing claims systems.
Appcino's Connected Claims Operation Suite of apps offers a complete claims management solution built on Appian. The multiple applications part of this suite includes FNoL intake, adjudication & settlement (multiple LoBs), fraud case management (integration with existing specialized fraud systems), field inspection management, subrogation, litigation case management, and claim finances management (reserves, payment, recoveries). It also comes with multi-channel customer service and process mining apps helping insurers to monitor and improve their claims processes continuously.