Azure Synapse Claim Fraud Analytics, 4-Wks POC

Azure Claim Fraud Analytics Solution leverages Azure Synapse unified platform in bringing together different aspects of data like data ingestion, big data analytics and data warehousing. Health Insurance users like Data Architects, Data Scientists, Data Analysts and Business users are facilitated by this solution. Azure Synapsis claim fraud analytics solution uses descriptive and predictive modelling with industry standard business rules to identify, score, and prioritize possible fraud cases.

FEATURES:

• Claim fraud Analytics enables automatic data feed and processing from both Insurance companies in-house and external TPA Claims.

• Readily available Data Warehouse for any Reporting needs.

• Identifying suspicious claims by Hospital, Patient, Corporate & External TPAs through FAMS Trigger using Fraud Score System

• Adopts industry standards rules to identity the fraud claims and recognizes the new pattern of fraud claims, adding those to the existing standard.

• Uses ML modelling and Power BI for better insights for predictive and descriptive analysis.

BENEFITS:

• On finding a typical pattern of fraud claims could avoid a huge claim expense and increase business value for current and future claims.

• Fraud detection converging time would drop to minutes from days.

• Build and identifying suspected Fraudulent Claims to avoid future fraud claims.

• Extensive fraud rules can be added dynamically into the framework.

• Reduce Premium for customers and Increase Insurance service by providing better products and plans.