The OLSPS Claims Segmentation Solution enables insurance companies to flag fraudulent claims.
Through the use of machine learning algorithms, the solution leverages the use of an insurer’s internal data to automatically assign a risk level at the point of claim registration, and then distributes the claim to the appropriate processing channel for settlement or further investigation.
This solution can be integrated with the insurer’s existing line-of-business systems, and is fully customizable to include particular business rules that are specific to the insurer. This will ensure claims are processed subject to the insurer’s internal rules and regulations.
Benefits of OLSPS Claims Segmentation Solution
Implementing the OLSPS Claims Segmentation Solution optimises the insurer’s business processes both by improving the odds of a claim sent to SIU being fraudulent and by reducing/negating assessment costs on low risk claims. This results in decreased operational costs; quicker turn around times for claims processing; and a higher satisfaction from customers.
Santam, a leading short-term insurance company in South Africa, wanted to improve its’ service to customers by settling claims faster, and keeping premiums low. Santam worked with OLSPS to design a predictive claims segmentation solution. The solution needed to integrate seamlessly with the current Santam claims process, and allow for real-time scoring of each claim, and a fast response rate. The designed solution works on a claim by claim basis.