TPA Brochure

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Our services

Fraud detection Detecting and preventing fraud is an integral part of our standard procedures. New claims are data washed through our counter fraud solution – Sentry – a bespoke, fully integrated tool linked to our case management system, which provides a tool used to screen claims data to score for fraud leakage. The system is automated to deliver the benefits of being quick, easy to pass data through for screening purposes and produces a Red/Amber/Green scoring for fraud. We are able to take our client’s claims data at an early stage of the claim’s lifecycle and screen it through Sentry for fraud identification. Clyde & Co also has a Fraud Hub comprised of specialist fraud lawyers and intelligence analysts who solely manage portfolios of suspected fraudulent claims. Our lawyers are some of the most experienced in the industry having dedicated their careers to tackling fraudulent claims on behalf of the industry. We also have an intelligence unit integrated into Our Fraud Hub. This means our analysts work alongside our lawyers to maximise the output of case investigations. Our intelligence team undertakes bespoke data washing projects for our clients each designed to maximise identification in line with the individual client’s strategic fraud priorities. We currently wash data on a

daily basis for a number of major UK insurers as well and national retailers. Our data washing unit can assist with adding an additional layer of fraud identification. For one motor client we have a 6% identification rate for suspected fraud risk and this process has formed the cornerstone of their initial claims and policy fraud identification strategy. Our approach to fraud management means that: - Genuine claims are processed swiftly, improving the customer (policyholder) journey - Any fraud risk is identified early, allowing for the intervention of the most appropriate resource at the first opportunity - Claims costs are controlled by using a proportionate approach to fraud screening and management - We are able to successfully identify organised fraud and fraudsters operating across different classes of business We deploy our Fraud Edge solution to provide a detailed risk profiling which can be incorporated into the client’s own fraud scoring models and handling strategies. This can provide insight into case conclusions and prospects of success with

valuable insight into opponents to help manage fraud exposure to suspicious entities. Interrogation of claim types allows us to explore own exposure and deploy relevant claims handling tactics.

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