AI/ML solutions for Fraud Detection & Prevention

About The Solution

In the past investigators and fraud analysts had to depend on tip-offs, intuition and few facts to detect a fraud. Due to availability of data and advance analytical tools it has become possible to uncover the fraud that were committed in the past as well as prevent the fraud from occurring by using the predictive analytics technique.

SoftSol has built a solution designed to solve the key problems in proactively identifying fraud in worker’s compensation industry. This solution identifies fraud and suspicious behavior, accurately quantifies theimpact, and provides actionable insights.

SoftSol’s solution enables data ingestion from various data sources located in client’s environment. The data is loaded into the solution’s database using the various adapters based on web services or batch jobs.

The machine learning based algorithms takes input from the fraud indicators repository and analysis the patterns in the data for predicting suspicious billing patterns, identifying suspicious behaviors as well as detecting outliers.

Some of the fraud schemes identified by our solution are:

• Kickback for referrals
• Unbundling
• Suspicious connections
• Excessive testing