Evaluate and compare L&A platforms with this practical selection scorecard. Assess architecture, native capabilities, AI automation, experience, implementation, vendor risk, and total cost of ownership to support confident modernization decisions.
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When ineffective fraud detection solutions cause lots of lost money to fraudsters, and drain resources in the many hours spent on extra touches, calls, reviews, and investigating false negatives — something needs to change.
Good fraud detection will cut out not only fraudulent payments, but also make fraud detection workflows more effective, so overall claims leakage goes down overall.
This is where intelligent, constantly-learning fraud detection driven by AI and machine learning comes in.
EIS offers these solutions with ClaimSmart™, which address fraud detection and cutting claims leakage with the combined powers of AI and machine learning.
But rather than simply tell you about it, we’ve decided to show you just how much of an impact it can make on your bottom line.
Our fraud detection ROI calculator uses your known fraud rate, average claim cost, total annual claims, and direct written premium amount to show you just how much AI and machine learning-driven fraud detection could save you.
What is ClaimSmart?
Our claims automation and fraud detection tool that can work on top of any core system, ClaimSmart is made up of two components:
- ClaimPulse™ revolutionizes claims automation with AI. It automates claims end-to-end, improving efficiency and reliability for customers and carriers. It starts with digital FNOL and real-time tracking, then uses pre-configured workflows to reduce manual work and speed up payouts.
- ClaimGuard™ uses AI and machine learning with advanced analytics to detect fraudulent or overstated claims without adding staff or slowing claims handling. It adapts to fraud trends by risk-scoring claims from extensive data, keeping insurers ahead of the latest fraud tactics.
How does ClaimSmart work?
Going above and beyond the typical operations of a claims management system, ClaimSmart sits on top and accelerates everything, making it all smarter from FNOL to close.
- When a claim is submitted, ClaimPulse takes care of intelligent FNOL while guiding claimants through the process, and ensures all information is prepped for more efficient downstream processing.
- With both claim, historical, behavioral, and other contextual data, ClaimGuard gets to work scoring each and every claim submission for its likelihood of fraud.
- As data is added to the claim, the score is adjusted accordingly.
- If a claim is clearly not fraud or is very low risk, it can continue moving through the system. Some can even move on to resolution if they are far enough below given thresholds and the fraud score is low enough.
- Suspicious claims are flagged with clear next steps.
In practice, this means claims are processed more quickly, more efficiently, and with greater data accuracy.
It also means claims adjusters can spend more time and mental bandwidth on difficult fraud cases, and that new fraud tactics start getting picked up on by the machine learning and AI before your human teams start to notice — saving you lots of cash.
What’s the benefit of ClaimSmart + EIS OneSuite?
ClaimSmart can work with any insurance core system, but there are some unique capabilities that get amplified within both ClaimSmart and EIS OneSuite™ when you use both that you don’t get with other core system + fraud detection tool combinations.
These include:
- Full picture analysis: Fraud scoring gets smarter when it has access to a customer’s billing and policy data, as well as their history of interactions with your company. This helps separate odd but legitimate behavior apart from suspicious activity that’s actually fraudulent.
- Customer-centric architecture: Due to the customer-centric architecture of our
- Fraud decisions within the workflow: ClaimGuard is built into ClaimSmart, so scoring leads to actions. Auto-triage, clear next steps, and fewer manual handoffs. That is direct labor savings
- Evergreen delivery keeps detection current and TCO down. Continuous updates mean you stay aligned with new fraud patterns without big upgrade projects that eat budget and stall progress.
Try the fraud ROI calculator today
If improving your fraud detection and cutting fraud-related costs are items on your priority list, start with a simple move: get a number you can take to your team to start working together on a solution.
