CLAIMS SEGMENTATION

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.

OLSPS Analytics Claims Segmentation Solution Process - 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.

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.

OLSPS Analytics Claims Segmentation Solution Benefits - 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

OLSPS is offering a free business consultation to help you understand how predictive technology can be utilised to solve your business challenges.

CASE STUDY

OLSPS Analytics successful projects logo Santam - Santam worked with OLSPS to design a claims segmentation solution using IBM SPSS Software - Enhanced Santam’s ability to detect fraud, saving them R17 million within four months of implementation

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.