Veritas2023-06-15T12:39:08+02:00

Detect fraudulent claims and pay valid ones almost immediately with

Veritas Propensity of Fraud Model

By reshaping your claims environment, you will prevent and detect fraud instantly, effectively and efficiently.

How?

Our VERITAS platform uses cohesive toolsets which includes machine learning (a collection of artificial intelligence (AI) algorithms trained with our historical data) to determine risk rule models and behavioural analytics enriched by automated multiple real-time data source inputs to predict and detect fraud while reducing false positives in order to preserve the customer experience.

Want to understand more?

IDENTIFY

Low risk claims to be paid almost immediately
Possible fraudulent claims

REDUCE

Client friction
False positive investigations
Admin burden

DETECT

Fraudulent trends
Syndicated activities
Opportunistic fraud

COLLECTIVELY
SAVED OUR CLIENTS

R35 125 082.00

BENEFIT BY IDENTIFYING FRAUDULENT BEHAVIOUR

The VERITAS fraud model uses one algorithm with hundreds of patterns, identifying low risk claims in seconds, whilst flagging possible fraudulent claims. The fraud model is constantly updated with real-time investigation and fraud scheme data.

  • Access supportive anti-fraud control measures
  • Prevent and detect fraud through sophisticated artificial intelligence solutions and machine learning fraud models
  • Rapid business decisions making with better outcomes
  • Instant cost-effective innovation without making use of internal resources responsible for day to day operations
  • Partnership for life

OPERATIONAL BENEFITS

  • Less false positive results
  • Less client friction and reputational damage
  • Holistic mitigation of fraud risk
  • Almost immediate payment of low risk claims
  • Competitive advantage due to increased sales
  • Product re-engineering
  • Enhanced decision making tool
  • 360 degree on daily risk profile

Evaluate your claims against Veritas –
reality doesn’t have to be painful.

Detect fraudulent claims and pay
valid ones almost immediately with

Veritas Propensity
of Fraud Model

By reshaping your claims environment, you will prevent
and detect fraud instantly, effectively and efficiently.

How?

Our VERITAS platform uses cohesive toolsets which includes machine learning (a collection of artificial intelligence (AI) algorithms trained with our historical data) to determine risk rule models and behavioural analytics enriched by automated multiple real-time data source inputs to predict and detect fraud while reducing false positives in order to preserve the customer experience.

Want to understand more?

IDENTIFY

  • Low risk claims to be paid almost immediately
  • Possible fraudulent claims

REDUCE

  • Client friction
  • False positive investigations
  • Admin burden

DETECT

  • Fraudulent trends
  • Syndicated activities
  • Opportunistic fraud

COLLECTIVELY SAVED OUR CLIENTS

R54 123 843.34

BENEFIT BY IDENTIFYING
FRAUDULENT BEHAVIOUR

The VERITAS fraud model uses one algorithm with hundreds of patterns, identifying low risk claims in seconds, whilst flagging possible fraudulent claims. The fraud model is constantly updated with real-time investigation and fraud scheme data.

  • Access supportive anti-fraud control measures
  • Prevent and detect fraud through sophisticated artificial intelligence solutions and machine learning fraud models
  • Rapid business decisions making with better outcomes
  • Instant cost-effective innovation without making use of internal resources responsible for day to day operations
  • Partnership for life

OPERATIONAL BENEFITS

  • Less false positive results
  • Less client friction and reputational damage
  • Holistic mitigation of fraud risk
  • Almost immediate payment of low risk claims
  • Competitive advantage due to increased sales
  • Product re-engineering
  • Enhanced decision making tool
  • 360 degree on daily risk profile

Evaluate your claims against Veritas – reality doesn’t have to be painful.

FAQ’s

Can insurers deliver simple and effective digital experiences while outwitting fraudsters?2022-08-03T11:03:37+02:00

To answer this question, you might consider one or more of the following important recommendations:

  • Select an integrated fraud management solution.
  • Raise your fraud intelligence by focusing on data quality and velocity.
  • Encourage internal and external data sharing for smarter fraud response.
What is the best solution that will help mitigate fraud risk in the insurance sphere?2022-08-03T11:03:01+02:00

Most insurers have some sort of fraud prevention and detection tool in place. They are either planning to adopt, currently adopting, or already have a solution in place, or planning to expand, enhance, or replace their existing solution. Obviously, the right tool is critical.

Automation and identity verification are critical to successful solutions. It is imperative that solutions come equipped with the right capabilities to be truly useful. When evaluating the technical capabilities of fraud detection and prevention solutions, insurers find the most value in automated processes, decisions, identity verification and authentication, and automated processes for making decisions.

Many of the insurance companies that XTND works with value an integrated, multilayered platform approach to fraud detection, which is interesting because many of them also say that the tools they have now are woefully inadequate.Without this integrated platform approach, insurers are forced to patch together various point solutions. If one solution, or one solution suite, can replace what once took many disparate tools, insurers will likely be able to cut down on management time and costs, improving bottom-line performance and, most importantly, contributing to a positive client experience.

When fraud is mitigated, insurers win and retain customers while cutting spending and losses. If fraud has the potential to derail business success, working to effectively detect and prevent fraudsters from wreaking havoc can drive business benefits. Insurers measure the ROI of fraud solutions via increased customer acquisition and retention and still expect an improved customer experience. Insurers also expect investigations or remediation costs and losses to decrease as well.

What is the least expensive phase for fraud detection during a policy’s life cycle?2022-08-03T11:02:42+02:00

Fraud occurs at all stages but is most likely to be detected during the marketing stage. Every stage of the policy life cycle is susceptible to fraud. For instance, misrepresentation and fraudulent documentation are most likely to occur during claims and portfolio management. However, all types of fraud are most likely to be detected during the marketing phase, as the insurer looks to acquire a new customer. Detecting fraud at this stage is necessary for the business; being able to prevent fraudulent claims and losses down the road means this is the least expensive phase for fraud detection. But it’s also a concern, as it means that fraud is going undetected in other stages, especially during the claims stage. In fact, the largest gap between occurrence and detection rates for all types of fraud exists in the claims stage. This leaves insurers open to fraud from people who focus on other steps or who can get past the initial marketing step without being caught.

What are the major problems insurers are facing in their anti-fraud initiatives?2022-08-03T11:02:15+02:00

Insurance fraud is a problem for both insurers and customers. Insurers are being squeezed to improve the performance of their fraud identification efforts while their anti-fraud initiatives aim to drive the best bottom-line results. Customers, on the other hand, continue to struggle through tedious claims processes or face delayed claim payments due to false positives. But what is it exactly that makes fraud such a dangerous and complex issue?

As customer interactions become increasingly digital and consumers themselves demand exceptional and seamless experiences, the insurance industry must contend with how these changes will impact the way they detect, mitigate, and prevent fraud. We believe there are three major problems for insurers:

  • The state of fraud is consistently evolving.
  • Customers demand exceptional experiences.
  • Aggressive fraud risk detection solutions place a good customer experience at risk.
What is the true scale of insurance fraud in South Africa?2022-08-03T10:56:03+02:00

International surveys are regularly carried out to estimate the true scale and cost of fraud to business and society. Findings vary, and it’s hard to get a full picture of how big the problem is, but all of these surveys show that fraud is common in organizations and remains a serious and expensive problem.

The risks of fraud will continue to increase as we see growing globalisation, more competitive markets, rapid developments in technology and periods of economic difficulty. Among other findings, the various surveys highlight that:

  • Organizations may be losing as much as 7% of their annual turnover because of fraud.
  • Corruption is estimated to cost the global economy about $1.5 trillion each year.
  • Only a small percentage of losses from fraud are recovered by organisations.
  • Fraudsters often work in the finance function.
  • Fraud losses are not restricted to a particular sector or country.
  • The prevalence of fraud is increasing in emerging markets.

Despite the serious risk that fraud presents to business, many insurance organisations still do not have formal systems and procedures in place to prevent, detect and respond to it. While no system is completely foolproof, there are steps that can be taken to align counter-fraud measures with customer experience in a digital world.

How can XTND support operational claims environments to achieve better results?2022-08-03T10:54:05+02:00

We believe in long-term partnerships, and we will work with you to improve and optimize your current process for preventing and finding fraud on all of your products. This will help you get better results in less time, with less effort, at a lower cost, and within the Policy Protection Rules and laws.

What assessment process does XTND follow?2022-08-03T10:53:06+02:00

XTND follows an end-to-end assessment process during the validation of any claim. Our focus is to identify and prove fraudulent activities during the new business process and subsequent claims process. Our assessment methodology supports a court-driven investigation. Our assessors are qualified as Certified Fraud Examiners and adhere to the highest ethical standards.

Will Veritas assist in reducing false positive flags in claims management?2022-08-03T10:51:51+02:00

Yes, it will reduce false positives. Traditional rule-based approaches to fraud detection, typically used in the insurance, banking, and medical aid industries, often result in many valid claims being flagged as suspicious, requiring unnecessary investigation. These false positive flags result in both unnecessary expenses being incurred, delays in paying valid claims and potential damage to relationships with clients. Our machine learning fraud models aim to identify fraudulent claims more accurately, greatly reducing the number of investigations performed without materially reducing the number of claims rejected due to fraud. The models also make it easy for XTND to quickly figure out which claims are very unlikely to be fraud. This means that these claims can be paid as soon as possible without causing any more trouble for clients.

What is Veritas?2022-08-03T10:51:13+02:00

XTND is the proud owner of VERITAS. A web-based analytical tool identifies high-risk insurance and medical aid claims based on historical and existing claims experience relating to fraud, waste, and abuse. Any institution needs to change faster than fraudsters by using cutting-edge tools and building fraud prevention into every step of the transaction chain.

VERITAS is a live system that refreshes and updates the fraud models as new data is received from various assurers. VERITAS uses sophisticated machine learning predictive models and fraud detection business intelligence rules to automatically sort claims. This gives each claim a personalized propensity for fraud risk score.

Who is XTND?2022-08-03T10:50:34+02:00

XTND is a well-established, South African-owned company with extensive experience in fighting white-collar crime and corruption. Our forensic specialists are internationally certified as Certified Fraud Examiners with expertise in fraud and corruption prevention, detection, and response strategies. For over a decade, we have adopted policies, processes, standard operating procedures, and several industry-leading initiatives to maximize the value-add to the forensic community, industry bodies, and the South African economy. XTND is a corporate member of ACFE SA, the professional body for forensic practitioners.

XTND’s forensic specialists believe that risk management in the current era and business environment can only be effective with a proactive approach using proactive solutions. XTND has been building and developing some of the best and most powerful software systems and models for detecting fraud for a decade.

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