The ClaimDirector solution from the Jersey City, New Jersey company works by analyzing various aspects of submitted claims and comparing them to known fraud indicators. It then assigns weighted values in different categories based upon those findings that are run through an algorithm that pumps out an overall score corresponding to the likeliness that the claim is fraudulent.
The claims adjuster can then be alerted to the score and determine whether the claim should be processed immediately or whether further investigation is appropriate. This is intended to add a layer of protection against red flags while at the same time making the processing workflow move faster.
“We wanted accurate and timely identification of potentially fraudulent claims through an objective and consistent approach,” said Lynne Brady, vice president of external fraud at Nationwide, who called technology’s role “essential in deterring insurance fraud.”
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