Data Detection and Investigation

For Government

Proactively prevent fraud, abuse and improper payments across your government agencies.

Detect, prevent and more effectively manage both opportunistic and professional fraud across your organization. Detection and Investigation for Government provides a single, end-to-end framework that uses multiple techniques – automated business rules, predictive modeling, text mining, exception reporting, network link analysis, etc. – to better identify fraudulent activity and stop payments before they are made. Precise targeting dramatically reduces false positives, ensuring that the vast majority of valid transactions continue without delay.

Detect fraud with greater precision, and reduce fraud losses.

Standardize, integrate and authenticate data, and consolidate program integrity activities. A robust fraud analytics engine processes all transactions (not just a sample) using multiple techniques – including automated business rules, predictive modeling, embedded AI and machine learning, text mining, search and discovery, exception reporting and network link analysis. Online, real-time scoring enables you to stop fraudulent payments before they are made. You can search databases of known fraudsters to detect repeat offenders, and record all outcomes, referrals and suspects within the system.

Gain a consolidated view of fraud risk.

Identify linkages among seemingly unrelated individuals and activities with a unique visualization interface that lets you analyze all related activities and relationships at a network dimension. Get a better understanding of new threats and prevent big losses early using social network diagrams and sophisticated data mining capabilities. The solution's search and discovery capabilities let you perform free-text, field-based or geospatial searches across all internal and external data, as well as refine searches using interactive filters and facets designed for investigators. And you can continually improve models and adapt the system to address changing fraud trends.

Increase efficiency and reduce costs.

Risk- and value-based scoring models accurately score and prioritize alerts before they go to investigators. This increases the ROI of investigators by ensuring they are working on the highest-value cases. A configurable workflow and intelligent case management tools enable you to systematically investigate, capture and display all information pertinent to a case, including interview notes and evidence needed for criminal or civil prosecution, restitution and collections. Auditing information related to user activities is captured automatically by the system, and you can configure the level of detail captured to meet your compliance needs.

For Healthcare

Prevent, detect and manage payment integrity issues from every angle. Detect and prevent health care fraud, waste and abuse at every stage of the claims process, and stop improper payments before claims are paid. SES Detection and Investigation for Health Care provides an end-to-end framework for ensuring payment integrity, with components for fraud detection, alert management and case handling.

Detect more fraud, reduce your losses and optimize payment integrity.

Spot more payment integrity breaches than ever before with a robust fraud analytics engine that processes all data (not just a sample) in real time or in batch. Running on the powerful Platform, the solution uses advanced analytics with embedded artificial intelligence (AI) and machine learning algorithms, combined with other techniques – business rules, outlier analysis, text mining, database searches, exception reporting, network link analysis, etc. – to uncover more suspicious activity with greater accuracy.

Gain a consolidated view of fraud risk.

Identify linkages among seemingly unrelated claims with a unique visualization interface that lets you go beyond individual and account views to analyze all related activities and relationships at a network dimension. Social network diagrams and sophisticated data mining capabilities give you a better understanding of new threats, enabling you to prevent big losses early. And you can stay on top of changes in payment and cost containment trends by continually improving models and adapting the system.

For Insurance

Detect, prevent and manage claims fraud across all lines of business

You don't have to accept claims fraud as a cost of doing business. SES Detection and Investigation for Insurance provides an end-to-end solution for detecting, preventing and managing both opportunistic and organized claims fraud across multiple lines of business, with components for fraud detection, alert management and case handling.

Detect more fraudulent activity.

Identify suspicious activity, uncover hidden relationships and detect subtle patterns of behavior at every stage of the claims process. Our insurance fraud analytics engine uses multiple techniques (automated business rules, embedded AI and machine learning methods, text mining, anomaly detection and network link analysis) to automatically score millions of claims records in real time or in batch. Customized anomaly detection methods reveal previously unknown schemes, linked entities and hidden crime rings, which can help stem larger losses. Get a consolidated view of fraud risk.

Identify linkages among seemingly unrelated claims, and identify cross-product fraud. A unique visualization interface lets you see customer claims and policies for all lines of business, and analyze all related activities and relationships at a network dimension. Social network diagrams and sophisticated data mining capabilities give you a better understanding of new fraud threats, enabling you to prevent substantial losses early. And you can stay on top of changing claims fraud trends by continually improving models and adapting the system.