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Fraud Detect System

FDS is an evidence-based detection technology to automatically verify if a file or image is genuine. FDS provides evidence for fraudulent claims based on scientific methodologies.

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Evidence based multi-layered detection

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Fraud detection on file level

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End to end detection with exact findings

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Workflow management to empower employees

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No false positives

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No end-point installation – works on web or integrated

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Proven business case with high ROI

The Challenge of Sophisticated Fraud

Claims processing in the modern insurance space often remains a manual, inefficient and error prone operation. It can easily take a trained forensic expert 15 minutes to one hour per submitted claims document and might still be imprecise, leaving room for fraud in anything from 5% to 10% of all claims. On a global scale, this adds up to billions of dollars. Unfortunately, the business model of the insurance industry passes on this huge bill to the consumer. The temptation for policyholders to commit fraud is associated with the low risk for legal repercussions. If a claims handler decides to investigate a claim further, the policyholder often drops the claim, whereas the insurer generally will not take further legal action as the value of the claim compared to collecting evidence and the cost of legal action is too high.

FDS highlights the area where changes have been made

FDS Detects, Identifies and Alerts if a File is Fraudulent

FDS is a software solution for forensic authentication and fraud detection, and detects fraud in seconds on file level, using over 100 detection points to verify if documents are genuine or fraudulent. FDS instantly determines whether a file is an unaltered original, an original generated by a specific device, or is the result of manipulation through editing software, suspicious geolocation, bearings etc. and therefore may not be accepted as claims evidence. FDS can detect a multitude of files which include images, invoices, receipts, certificates, health records, employment contracts, warranties and other such documents.

Why is File Detection Technology Needed?

The ability to deal quickly with claims is core for any insurance company to ensure high customer satisfaction scores, and at the same time, reducing claims costs by offering efficient claims handling services. FDS supports efficient processing whether it is traditional in-house manual claims management or automated self-service, also known as “STP” or “Fast-track”. Traditional pattern-based fraud detect system is a common technology used in the insurance industry and gives a good indication of fraud patterns. However, it tends to give a number of false positives that are time consuming and costly to confirm. FDS is an extra layer of detection on top of your existing fraud systems, such as business intelligence and AI solutions.

The Detection Engine

FDS detects on submitted claims documents such as; images, Word, Excel, PDF’s and films. FDS provides evidence for fraudulent claims based on scientific methodologies. The FDS detection engine has all detection methods and features, including parametric options and setup stored in the database so they can be customized. A Windows service inspects all meta-data of all files, including advanced deep inspection and analysis of all data inside PDF files, and it will even highlight where modifications in a PDF file have been made.
FDS supports Google API in order for the claims handler to easily see the policy holder’s address, the address of the reported incident, and the GPS data location of submitted images. It is easy to compare, calculate and view on a map the distance between reported location and actual location. FDS makes a fingerprint (several HASH values) of all files, making it possible to alert if the same file has been submitted in previous inhouse cases. By using FDS Data Point, these fingerprints can be checked in a GDPR regulated environment on a centralized database of all participating insurance companies. Alerts are raised if the same claim, or part of it, has been used before.
For reverse image search, the FDS integration to TinEye, will reveal if images have appeared on the internet before. FDS features an open RESTful Web API interface for easy integration with other insurance platforms and supports self-service or STP strategies.