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). A variety of business benefits 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.

This report provides an overview of claims fraud-detection solutions for health insurance carriers. The report profiles five solutions, providing an overview of their functionality, customer base, technology, SaaS capabilities, implementation, pricing, and support.

Note: The companion report to this series, So You Want to Buy a Fraud Detection System, 2024 Edition, will post in late August 2024. (At that time, a live link will be added to both vendor reports)