SUSPECTED FRAUD

The cost of Insurance fraud is over $80 billion problem for the Property and Casualty, and Life Insurance Industries. The Charleeā„¢ Artificial Intelligence generated insights provide Quality Control Alerts (based on industry best practices) and Red Flags with scoring for the Claims Examiner to take the appropriate action with the claim.

RedFlags/Quality Control Alerts for Potential Fraud

Use Case #SF1

Description: The Charleeā„¢ Insurance Insights Engine (patent pending) has over 40,000 insights to help Claims Examiners identify potential fraud.

Insurance Fraud is a significant problem for the Insurance Industry and the Consumer. The Claims and Underwriting teams need to leverage Artificial Intelligence-generated Insights to identify patterns and activities for potential fraudulent claims and policies.

The Special Investigation Unit (SIU) is responsible for investigating and bringing these claims to a proper conclusion. The Charleeā„¢Insurance Insights Engine provides A.I. generated insights for identifying QC Alerts (industry best practices) and Red Flags pattern recognition to identify suspected fraud schemes and behavior.

The ability to leverage the correct data at the right time for the right person to make the right decision for the proper disposition of suspected fraudulent claims is critical in the avoidance and mitigation of fraud. Charleeā„¢ gives your anti-fraud team more power in discovering essential insights in the unstructured text in files.

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