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Real Business Problems Solved By Forturance
The Problem
A top US Health insurance company was concerned about patterns of claims from particular hospitals, doctors, geography and patients but had no consistent source of investigative data to initiate
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The Solution
Siren Fraud Intelligence
The Health Insurance company was able to collect and link all claims into a single Siren environment. This allowed a single repository of documents, databases, emails and all forms of correspondence in a single place. From that a knowledge graph was built and connections.
The Outcome
Greatly Reduced Fraud Risk
The Fraud Research function has for the first time solid irrefutable facts on patterns of patients claims which could be rejected from particular doctors and hospitals. Having documentary relationship models and patterns gave the legal backup to hold firm saving the firm millions of dollars on fraudulent claims. This system can be used entirely by Fraud Research professionals without the requirement for frequent IT
