The headline stats

1
day
Time to build fraud model
5
mins
Time to deploy fraud model
£
1100
m
Annual UK insurance fraud
£
200
m
Spend on insurance fraud

Fraudulent claims are costly

An insurer's most important to its policyholders is to pay claims. For policyholders, this means paying the right claims quickly. In a small number of cases, a claim may be invalid and should be blocked. This also benefits policyholders - if a claim is fraudulent or is not covered by the policy terms and the insurer pays these claims, it increases costs for other policyholders and reduces profits. For this reason each claim must be evaluated before payment is made.

A human cannot ajudicate all claims for insurers with high claim volumes. Claims departments need to be able to filter out clearly valid claims and pay them quickly, as well as identify claims that need further investigation. In addition, complex claims can be identified earlier and pushed to more experienced claim handlers, reducing the cost of claims handling. This improves the customer experience and makes the process more efficient.

Creating a claims triage model

The most effective and cost-efficient way to filter claims is to use a fraud model that makes an initial triage decision quickly and moves claims into the correct workflow. The model should identify claims that are clearly not fraudulent for payment, identify fraudulent claims for investigation and direct more complex claims for inspection to senior claims assessors. This makes the most efficient use of the claims assessing department, and has been proven to reduce the cost of claims significantly as well as the claims expenses.

Optalitix Models helps convert Excel fraud models into APIs

This type of claims filtering model is challenging to build into claims systems as the developers who understand the code must interpret complex rules set by claims assessors in core claims systems, and then update them as the assessors change their views. But building the logic in Excel is easy – most claims assessors understand Excel well and know what the filtering rules should be.

With Optalitix Models, these spreadsheets can become high capacity, super intelligent systems in minutes.

Benefits to insurer

  • Significant claims savings are possible if the correct claims are checked.
  • Reduced claims expenses due to improved workflow processes.
  • Easier for claims assessors to build claims filtering rules into Excel.
  • Easier for developers to connect claims systems via APIs.
  • Rapidly update claims rules without needing developers to implement changes. 
  • Optalitix Models can process millions of calculations.

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Use cases

Underwriting workbench

Time to deploy models
<
5
mins
Est reduction in dev cost
80
%
Lines of business covered
>
15
Estimated ROI
>
10
x
See how we do it

Lending & Mortgage Portal

Loans issued to date
£
7
bn
Existing brokers integrated
6000
Reduction in development cost
70
%
Loans issued
>
25000
See how we do it

Personalised Insurance Pricing Models

Consumers expecting personalisation
71
%
Ecommerce companies using personalisation
74
%
Potential uplift in sales
50
%
Time to deploy models
3
mins
See how we do it

Fraud Detection Model

Time to build fraud model
1
day
Time to deploy fraud model
5
mins
Annual UK insurance fraud
£
1100
m
Spend on insurance fraud
£
200
m
See how we do it

Sales Probability Calculator

Increase in sales
50
%
Leads leading to 80% of sales
20
%
Accuracy
>
70
%
Increased sales efficiency
40
%
See how we do it

Spire Hospitals: Forecasting Clinic Attendance

Accuracy of predictions
80
%
Reduced non-attendance
30
%
Speed of response
<
100
ms
System scalability (nr of calcs)
>
100
m
See how we do it

Monitoring Energy Usage

Increase in battery efficiency
15
%
Speed of response
<
50
ms
Scalability (nr of calcs)
>
100
m
Time to update model
<
3
minutes
See how we do it

Optimising Clinic Bookings

Increase clinic utilisation
20
%
Boost in profitability
50
%
Update time
3
minutes
Clinics using system
30
See how we do it

Credit Calculator

Reduction in development time and cost
90
%
Avg model response time
<
100
ms
Scalabilty (nr of calcs)
>
4
m
Loans issued to date on the system
£
7
bn
See how we do it

Insurance Calculator Models

Reduction in run time for batch calculations
90
%
Models hosted
>
5000
API calculations
>
4
m p.a.
Calculation nodes available
>
20
See how we do it

Create An Online Pricing Model

Time to deploy pricing model
<
5
mins
Scalability (nr of calcs)
>
100
m
Calculation speed
<
100
ms
Quotes processed
>
95
mil
See how we do it

Innovation In Finance and Banking

Loans issued p/a
> £
1
bn
Reduction in system build cost
80
%
Scalability
>
4
m p/a
UK brokers connected
>
6000
See how we do it

Insurance Policy Validation

Reduction in development time and cost
90
%
Number of database calls
>
100
m
Single hosted platform for all policy validations
1
platform
Security Certificates
ISO27001
& CyberEssentials
See how we do it

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