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Advanced Analytics for Claims Processing and Fraud Detection

Advanced Analytics for Claims Processing and Fraud Detection

LexisNexis® leverages powerful predictive models and scoring technology to help carriers accurately assess claims and improve decisions throughout the life of the claim. Our analytics tools help you illuminate complex and high-risk claims, and more easily prioritize and fast-track safer transactions while enhancing the customer experience. Analytics capabilities include predictive modeling, entity resolution, relationship analytics, text mining and business rules.

Predictive Modeling

LexisNexis® uses a toolbox approach to predictive modeling, incorporating the best in machine learning and statistical modeling techniques as appropriate. Because claims by their nature generate different data at different times throughout the life of the claim, LexisNexis® uses a set of models each tuned to the coverages and data available at any given point. This approach has proven to provide highly accurate, highly stable results in operational environments.

Entity Resolution

Entity resolution at LexisNexis® draws on the largest repository of proprietary and third party data within the industry, including information for more than 276 million U.S. consumer identities that are continually refreshed from more than 10,000 different sources from both traditional and new sources of data. These vast data records, combined with our patented, scalable and automated linking technology enables us to tie more data points to a person or asset than the minimum required by most matching logic rules. This capability helps to eliminate false positives and provides a more comprehensive and accurate view of an individual, property, asset or other entity for more efficient claims processing and proactive fraud investigations.
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Text Mining

A large portion of the data associated with a claim is contained in unstructured data fields such as adjuster notes, customer communications, and loss descriptions. Natural language processing techniques that analyze unstructured data add valuable information to analytics not explicitly available in structured data fields. LexisNexis® has more than 15 years of experience providing claims solutions using advanced proprietary text mining techniques that gather, integrate and analyze disparate text-based information from first notice of loss and throughout the life of the claim. By using text-derived information, we are able to improve the accuracy of analytics and allow for earlier assessment of claims.