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RiskShield from INFORM assesses the potential for claim fraud at first notice of loss, medical billing fraud, and performs risk assessment within insurance application data. Finally, working with our customer’s internal management systems, RiskShield can optimize the entire claims process from start to finish allowing clean applications, bills, and claims to flow smoothly and quickly through the system ultimately providing positive customer service. 

With a predictive approach, RiskShield incorporates time proven methods such as fuzzy logic, pattern recognition, business rules, and the use of both internal & external data sources to score claims quickly and effectively resulting in valuable insights of fraudulent behavior. Sounds complex to maintain, but RiskShield’s rules can actually be created, tested, verified, and deployed in real-time by fraud specialists of insurance companies themselves without any vendor support, IT support, or system downtime. 

Overseeing our core processes, RiskShield’s Business Intelligence dashboard can be configured to analyze active alerts & key performance indicators to uncover hidden patterns or unusual behavior ultimately maximizing our customer’s fraud detection performance and minimizing the number of false positives. Canned & ad-hoc report management can then provide reports as desired by our customers.

RiskShield is used in more than 25 insurance companies currently in Europe and North America, protecting some of the world’s largest insurers, including AXA, GEICO, and Zurich with many of our customers experiencing ROI return rates up to 7:1 per annum.

For more information, call us at 949-293-2793 or send an email at riskshield@inform-software.com.

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Insurance Fraud typically occurs when an insured or claimant fraudulently obtains a benefit or advantage to which they are not entitled or when an insurance provider intentionally denies a beneficiary some due benefits. The United States Federal Bureau of Investigation (FBI) notes that the most...

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