WHAT IS CLAIMSGATOR?
ClaimsGator is a loss prevention offering that uses proprietary analytical technology for detecting patterns of abuse in insurance or warranty claims.
Manufacturers such as tire companies, consumer electronics companies, automotive OEM manufacturers etc. can use ClaimsGator to diagnose patterns of service abuse by channel partners or use ClaimsGator as an early warning system to detect patterns of product failure. Insurance companies, healthcare or Property & Casualty, can use ClaimsGator to diagnose and curb underwriting or claims fraud. In particular, ClaimsGator is useful for identifying patterns of collusion (patent pending) among service providers. ClaimsGator has an easy to use, web based solution for curbing fraud in the insurance claims process.
There are two versions of ClaimsGator
- ClaimsGator for Manufacturers: You will need this solution if you are responsible for managing your company's warranty reserves, service & support costs, or product quality metrics.
- ClaimsGator for Insurers: You will need this solution if you are responsible for managing the loss ratio or for running the claims investigation unit for the insurer.
Benefits
ClaimsGator identifies claims abuse across the following five categories.
- phantom clients and/or claims,
- collusion among service providers,
- double billing ,
- gouging or unnecessary services rendered,
- process or policy abuse.
For manufacturers, ClaimsGator can also be used to diagnose systemic issues among warranty claims, especially when claims frequencies are far in excess of estimated failure rates.
The biggest benefit of the solution is in loss reduction. For example, industry reports estimate that every $1 in warranty fraud costs a company $2.80 or more due to customer satisfaction issues, lost part sale and investigation costs. ClaimsGator will not only identify fraud but also help in making sure you recover the losses to fraud. An insurance company would use this solution to trim fraud, reduce its loss reserve liability and thus boost its bottom line.
Because the solution is web based, you will not need to invest in systems integration time, effort and expenses. The web based solution is easy to understand and time will not be needed in training the team.
Finally, our experience suggests that you will notice a bump up on customer satisfaction. There are typically three reasons for this. ClaimsGator will ensure service providers are not abusing the system, the insurance premiums (or the equivalent cost of service) will get lowered in the long term, and clients appreciate the direct communication between you and the end user.
Pricing
Solution pricing is based on a number of factors. The pricing model uses the following input
- Claims volume
- Frequency of audits
- Customization requirements on entity scorecards
- Customization requirements on web based workflow management solution
- Average claim amount
- Estimated fraud rate
Design Features
The guiding principle for the design is that the solution must augment your investigator team's capabilities without requiring a technology or personnel overhaul. Hence the solution interface mirrors the claims investigation process. The design amplifies the investigator's ability to detect fraud. You will find that the fraud detection techniques mirrors the investigator's own intuitive thought processes.
The web-hosted software model was used for its simplicity, elegance and cost effectiveness.
A 2009 study by IBM polled 2500 chief information officers globally and found a keen focus on cost-cutting and on analytics. ClaimsGator is a reflection of the industry paradigm. It is not only a state of the art analytical business solution, it is also the most cost-effective deployment of its kind in the market. ClaimsGator comprises four components -- a data layer, an analytics layer, a web-based presentation layer and an investigation service.
- The data layer receives claims data from the client and processes it into a proprietary data mart for use in the analysis.
- The analytics layer uses proprietary algorithms to identify instances of fraud and delivers the results via the web based presentation layer.
- The web-based presentation layer is a secure interface for submitting raw data and receiving reports and updates on ongoing investigation.
- The investigation service is available to you if you want physical evidence on the suspicious entities. If required, our investigators can conduct field audits and collect evidence to conclusively prove fraud and facilitate collections.
The solution is unique in that it has a basic, but complete, case management system integrated into the interface.You can deploy the basic ClaimsGator package in under four weeks to become operational. The bulk of elapsed time is used to set up the data transfer processes. The solution can also be customized per the following.
- User Interface
- Customized dashboards for monitoring claims and the investigation process
- Unique fraud detection rules (particular to your business)
- Intranet deployment
- Customized investigation reports
- Scope of the field audits
More information
Click on this link to launch a video on the solution.
For more information on ClaimsGator, please contact us.