A large NYSE listed company achieves 10X ROI in Fraud Prevention and Saves Millions in Workers Compensation Fraud
At A Glance
Accurately quantified the impact of provider fraud
Our client through its subsidiaries, operates in the commercial property and casualty insurance industry primarily in the United States. It offers workers’ compensation insurance to small businesses in low to medium hazard industries.
Like most Insurance companies, our client too has a special investigation unit (SIU) to detect and prevent workers compensation fraud. For the past 10 years, the SIU used legacy systems to analyze suspicious claims. This included extremely large volumes of data and millions of records related to claim transactions and billing. The existing system involved a lot of manual work and proved to be very time-consuming. With basic data analytics it was difficult to detect the fraudulent transactions and also get a consolidated view of fraud to analyze and close cases faster. The team spent weeks and months trying to gather transactions to support the legal case.
“Aquila is state-of-the-art solution with comprehensive use cases to detect fraudulent transactions for any SIU. The solution has helped us discover large scale systematic frauds by means of collusion among various bad actors. It is easy to use and extract reports without relying on IT resources. The solution has delivered 10X ROI and paid for itself in the first year of its adoption.”
The solution is built using latest technology like AL/ML and has the ability to see through colluding transactions and actors. The system provides suspicious fraud score which helps the SIU team focus their energy to unearth potential fraud scenarios. Aquila provided a fraud analytics solution with multiple modules including Provider Dashboard, Link Analysis and Claim Analytics that would support over 25 use cases of fraud.