Angoss ClaimGUARD is an industry-leading predictive claims fraud and abuse detection solution providing a suite of proven analytics capabilities and domain expertise to reduce and prevent the costs of fraudulent or abusive transactions for providers of public and private health care and benefits insurance.
Angoss ClaimGUARD helps health care insurers apply advanced data mining and predictive analytics capabilities quickly and easily to their claims data to:
- Reduce Costs with Improved Detection of Claim Fraud and Abuse - quickly detect, document and expedite investigation of suspect providers, claimants, and claim-level behavior with keen models capable of detecting subtle patterns of unusual activity. Angoss' sophisticated and adaptive pattern detection system is extremely difficult to outmaneuver and can discover new schemes before they become prevalent.
- Actively Deter Fraud and Hasten Recovery - with arapid Claims Fraud Scoring engine and list generation capabilities, providers can quickly and easily distribute greater numbers of better targeted verification letters that are fully detailed with relevant claim history and data.
- Analyze Claims Portfolios to Support Client Satisfaction and Account Management Objectives - provide account and claims managers with detailed insight to key drivers of claims costs and loss ratios. Insurers using ClaimGUARD can quickly and proactively identify clients with high levels of exception claimants and providers before concerns are realized by the clients themselves.