Top Financial Fraud Detection approaches:
Common features:
a)
b)
c)
d)
e)
f)
g)
h)
i)
Access Security Management
Check Fraud Monitoring
Custom Fraud Parameters
For Banking
For Insurance Industry
Internal Fraud Monitoring
Investigator Notes
Pattern Recognition
Transaction Approval
Financial Fraud Detection tools:
1. FraudLabs Pro
Features:
a)
b)
c)
d)
For Banking
Custom Fraud Parameters
Pattern Recognition
Transaction Approval
Ref: FraudLabs Pro, Founded: 2004, Malaysia, www.fraudlabspro.com
2. Riskified
Riskified is an advanced eCommerce fraud prevention tool designed to drive sales
and reduce management costs. As a reliable end-to-end card-not-present (CNP)
fraud software, Riskified helps businesses prevent online fraud by reviewing,
approving, and guaranteeing their orders. With Riskified, every approval is
covered by a chargeback guarantee in case of fraud. Additionally, Riskified’s
quick, frictionless review process enables retailers to boost their sales and expand
confidently to new markets.
Features:
a) Pattern Recognition
b) Custom Fraud Parameters
c) Transaction Approval
Training:
a)
b)
c)
d)
Documentation
Live Online
n Person
Support
Online:
Business Hours
24/7 Live Support
Deployment:
a) Cloud
b) Infrastructure as a service (IaaS)1
c) Web
Ref: Riskified. Founded: 2012. United States. www.riskified.com
3. Emailage (Global Fraud Prevention & Email Risk Scoring)
1
Infrastructure as a service (IaaS) is a cloud computing offering in which a vendor provides users access to
computing resources such as servers, storage and networking. Organizations use their own platforms and
applications within a service provider’s infrastructure.
Emailage is tailored for eCommerce, FinTech, Ticketing, Airlines, and the
Travel/Leisure industries. Optimal for CNP, Account Opening & Maintenance,
Lead Scrubbing, Platform Integrity, etc.
Features:
a)
b)
c)
d)
e)
For Banking
Custom Fraud Parameters
Internal Fraud Monitoring
Pattern Recognition
Transaction Approval
Deployment:
a) Cloud
b) SaaS
c) Web
Training:
a)
b)
c)
d)
Documentation
Webinars
Live Online
In Person
Online:
a) Business Hours
b) 24/7 (Live Rep)
Ref: Emailage, www.emailage.com, Founded 2012, United States
4. Simility
It has been performed especially well with banks, financial services companies,
insurance companies, and a variety of other businesses.
Deployment:
a) Cloud
b) SaaS
c) Web
Training:
a) Documentation; Webinars; Live Online; In Person.
b) Support: Online and 24/7 (Live Rep)
Features:
a)
b)
c)
d)
e)
f)
g)
h)
i)
Access Security Management
Check Fraud Monitoring
Custom Fraud Parameters
For Banking
For Insurance Industry
Internal Fraud Monitoring
Investigator Notes
Pattern Recognition
Transaction Approval
Ref: Simility, simility.com, Founded 2014, United States
Vigilance:
Who Uses This Software?
Vigilance protects your company's hard-won cash from those fraudsters that want
to steal it from YOU! Vigilance does this by receiving payment batch files from
the company’s accounting/payroll system and then uses numerous algorithms and
AI smarts to review and compare the BANK ACCOUNTS associated with each
proposed payment. It then highlights these to the appropriate authorizer and/or
owner so suspicious transactions can be further reviewed PRIOR to payment.
Features:
a)
b)
c)
d)
Check Fraud Monitoring
Custom Fraud Parameters
Internal Fraud Monitoring
Pattern Recognition
Training:
a) Webinars
b) Live Online
Deployment:
a) Cloud
b) SaaS
c) Web
Ref: Vigilance Fintech Software, www.vigilance.co.nz, Founded 2015, New
Zealand
5: BOLT
Single, intelligent platform that replaces fragmented checkout, payment, and fraud
software. Seamless checkout, zero fraud.
Deployment:
a)
b)
c)
d)
Cloud
SaaS
Web
Installed - Mac
e) Installed - Windows
f) Mobile - Android Native
g) Mobile - iOS Native
Training:
a) Documentation
b) In Person
Support:
a) 24/7
b) (Live Rep)
Ref: Bolt Financial, bolt.com, Founded 2014, United States
6: Insights on Demand
Oversight Insights on Demand is a web-based software solution that automates
spending program compliance by comprehensively analyzing expense report,
purchase card, and accounts payable transactions to identify fraud, non-compliant
purchases, and wasteful spending. Through visibility into the interaction between
policy and behavior, Oversight offers opportunities for ongoing improvement, and
helps organizations transform how they are managing risks in their spending
programs.
Features:
a)
b)
c)
d)
e)
f)
Check Fraud Monitoring
Custom Fraud Parameters
For Banking
For Insurance Industry
Internal Fraud Monitoring
Investigator Notes
g) Pattern Recognition
h) Transaction Approval
Training:
a) Documentation
b) Live Online
c) In Person
Deployment:
a) Cloud
b) SaaS
c) Web
Support:
c) 24/7
d) (Live Rep)
Ref: Oversight Systems, www.oversightsystems.com, Founded 2003, United
States
7: Signifyd
As the world’s largest provider of Guaranteed Fraud Protection, Signifyd delivers a
100 percent financial guarantee against fraud and chargebacks on every order
approved. This shifts the liability, allowing merchants to increase sales and focus
on their core business without worrying about fraud. With Signifyd, you can accept
more orders, improve customer satisfaction, and scale your business globally.
Features:
Vendor has not completed this information.
Training:
a) Documentation
b) Live Online
c) In Person
Deployment:
a) Cloud
b) SaaS
c) Web
Support:
a) 24/7
b) Business Hours
c) (Live Rep)
SAS, Detection and Investigation for Insurance:
Detect, prevent and manage claims fraud across all lines of business.
Key features:
1. Data management

Provides an insurance-specific fraud data model.

Consolidates historical data from internal and external sources – claims
systems, watch lists, third parties, unstructured text, etc.

Eliminates or reduces redundant or inconsistent data with the solution’s
built-in data quality tools.

Seamlessly integrates with existing third-party systems.
2. Advanced analytics with embedded AI and machine learning

Provides a broad set of modern statistical, machine learning, deep learning
and text analytics algorithms from within a single environment

Enables you to improve fraud models by testing different approaches in a
single run, and comparing results of multiple supervised learning algorithms
with standardized tests.

Provides an array of analytical capabilities, including clustering, different
types of regression, random forests, gradient boosting models, support
vector machines, natural language processing, topic detection and more.

Continuously updates and improves models based on prior output results.
3. Rule and analytic model management

Provides prepackaged heuristic rules, anomaly detection and predictive
models, so you can harness the power of advanced analytics right out of the
box.

Let's you create and logically manage business rules, analytic models, alerts
and watch lists.

Enables you to customize analytical models to identify claims fraud not
found by existing business rules.

Enables easy management of the deployment, aggregation, scheduling,
suppression and routing of simple or complex rules across multiple factors,
such as parties, data sources and business lines.

Let's you run groups of rules and models alone, in parallel or at different
times (intraday, daily, weekly, monthly, etc.).

Facilitates collaboration with other business units on model development.
4. Detection and alert generation

Calculates the propensity for fraud at first submission, then rescores claims
at each processing stage as new claims data is captured.

Reviews claims early in the adjudication process so you can stop suspicious
activity at the prepayment stage.

Enables you to incorporate fraud detection methods into the process at the
most appropriate points – e.g., cases where anomaly detection scenarios may
require data that is not available until later in the adjudication process.
5. Alert management

Combines alerts from multiple monitoring systems, associates them with
common individuals and provides a more complete perspective on the risk of
particular individuals or groups.

Prioritizes the investigative order of alerts by scoring them in real time,
based on specific characteristics.

Automatically routes alerts to appropriate team members based on user-set
rules and requirements.

Displays all evidence for each case on a dashboard that you can customize to
accommodate your investigative unit's processes.
6. Social network analysis

Provides a unique network visualization interface that lets you analyze
related activities and relationships at a network dimension, and identify
linkages among seemingly unrelated claims.

Enables you to produce complete dossiers of networks surrounding a case,
and gain fast access to full details on all related parties and networks.

Produces independent and combined fraud scores, so you can assess overall
risk on a customer, claim or network basis.

Increases investigator effectiveness by enabling investigators to merge and
delete network entities, and add annotations (text and images) to specific
entities in a network.

Provides time slider functionality, which enables you to see how activity in a
network develops over a time horizon.
7. Search and discovery

Enables free-text, field-based or geospatial searches across all data (internal
and external).

Let's you refine searches using interactive filters and facets that are
customized for the claims and SIU teams.

Provides full entity descriptions that include other linked entities, which you
can open and explore to evaluate the likelihood of fraud.

Provides an intuitive interface that lets you construct complex queries
without the need to understand specific syntax. For example, you can use
fuzzy searching, proximity searching and field boosting while restricting
searches to specific entity types, fields, comments or insights.
8. Case handling

Systematically facilitates investigations using a configurable workflow.

Stores all information pertinent to a case, including detailed investigation
information

Assesses overall fraud exposure, including losses due to fraud as well as
fraud detected or prevented.
9. Flexible deployment options and analytical services

Enables faster implementation (and faster ROI) when installed and
administered at the SAS hosting site, eliminating the need for staff to
oversee the system.

Can be hosted at your site, with SAS providing implementation assistance
and training.

Can be fully integrated with your existing operations environment, workflow
solution and business process management objectives, including thorough
business process discovery and review to ensure your objectives are met or
exceeded.
Ref: www.sas.com
IBM Insurance Fraud Analytics:
IBM’s insurance fraud specialists have run national and international counter-fraud
operations for leading insurers and can help optimize the full range of people,
process and technology. IBM’s specialists can help you:
1. Assess the current state of your counter-fraud program against industry best
practices for the dozens of dimensions of the IBM counter-fraud maturity
model.
2. Identify and prioritize practical opportunities for improvement.
3. Create a target operating model to design organizational constructs, operational
governance and technology architecture.
4. Provide rapid prototyping to demonstrate business value for enterprise-wide
protection.
5. Deploy and integrate counter-fraud technology.
6. Utilize counter-fraud capabilities as a service—including subscription-based
models for hosting; application management; behavior modeling, scoring and
analytics; and referral generation.
The end-to-end solution supports the key phases of the fraud lifecycle:
1. Detect: Score and rescore claims, requests or entities using rules and multiple
analytical fraud models in real time, embedded in the business process, to
detect potential fraud earlier and avoid pay-and-chase situations.
2. Respond: Apply deep insights to take the next best action for a claim with
confidence. Differentiate legitimate actions from suspicious ones, respond
immediately to suspicious patterns and activities and encourage fraudsters to
abandon planned schemes.
3. Investigate: Turn fraud intelligence into action. Perform and manage deep
inquiries into suspicious activity to compile evidence and build cases.
4. Discover: Facilitate learning and enable continuous improvement in fraud
detection by analyzing historical data, assessing patterns and building watch
lists for potentially fraudulent individuals and organizations.
5. Improve: Utilize analytics to monitor current and potential exposures and
identify areas of improvement in the effectiveness and efficiency of your fraud
management efforts.
Ref: www.ibm.com/analytics/us/en/business/fraud-protection/insurance-fraud
FRISS: AI Powered Fraud Detection
FRISS enables insurers to:
1.
2.
3.
4.
Know Your Customer before they enter your portfolio.
Prevent bad risks by combining AI and machine learning analytics.
Enable straight through processing (STP).
Deliver seamless customer onboarding in a split second.
Automated Risk Assessment Benefits:
1. Straight Through Processing (STP)
By implementing automatic risk estimation in the underwriting process, straight
through processing is being realized wherever possible. This allows your operation
and process for underwriting to become significantly more efficient. With FRISS,
you can identify and target those applications that are suspicious.
2. Real-time Objective Risk Assessment
The risk mitigation process provides you with structured and uniform screening,
saving you a significant amount of time, while giving you real-time insights into
the risks associated with a new customer request. With these insights, you can
directly accept, reject or accept under customized conditions.
3. Improve Customer Experience
A smooth onboarding process delivers happy customers. The consistent and
impartial screenings enable fast onboarding within a split second. Time to market
new products that fit the changing market requirements goes faster, while you stay
in control of your portfolio growth.
4. Know Your Customer
FRISS helps you to answer three basic questions:

Who am I doing business with?

Am I allowed to do business with them?

Do I want to do business with them?
With the FRISS score, the risk profiles are created automatically. By using
proactive monitoring of current customers, preventive measures can be taken in
time, in case of changing risks. Moreover, mutated risk profiles that flow from
both proactive monitoring and the claims process will be filed and used to improve
current and future screenings.
5. Underwriting Protection
Insurance is changing fast. On Demand insurance, Usage Based Insurance (UBI)
and Blockchain all change the way in which you do business. With FRISS and our
Risk Assessment at Underwriting you are prepared for the future. Real-time
application scoring enables on the spot insurance, where ever your customer is at
that moment.
6. Data Driven Underwriting
The FRISS underwriting solution leverages extensive, out-of-the-box internal and
external data sources to paint the full picture of the customer. Combined with our
AI powered risk analysis, you can easily identify potential risks and really know
your customer (KYC.) before accepting the risk. You can decide on the amount of
risk you are willing to take before bringing the customer into your portfolio. With
FRISS, you can turn your data into knowledge.
Ref: www.friss.com/solutions/risk-assessment-at-underwriting
AQUILA: Insurance Fraud Detection Solution
This Provider Fraud discovery and red flag detection solution is built by
incorporating 20+ use cases like up coding, unbundling, cluster billing etc.
algorithms with the use of both internal and external data. It uses the medical bills
and other claim related data to discover fraudulent activities and marks them as red
flag bills.
KEY FEATURES
1.
2.
3.
4.
5.
6.
7.
8.
9.
Leveraging BIG DATA for ingesting internal & external data
Flagging more than 20 provider use cases
Providing Google like search capabilities
Providing export/download features to provide evidence
Provide rich analytics to visualize the fraud trends
Provides alerts for set rules for to watch for a provider bill
Patterns of billing, relationship between different parties
Ingesting external data for overview of the provider
Getting alerts from FBI etc.
BENEFITS
1. Special Investigation Unit (SIU) can focus on investigating the fraudulent case
rather than spending time looking for one
2. More fraud case can be closed
3. Dependency on IT is reduced by more than 80%
4. Pre-built rules engine that reduces implementation time.
5. Allows modular build so can customize easily.
6. Solution incorporates many security features like network segmentation,
encryption of hard drive etc.
7. Provides casework collaboration.
8. Solution is HIPPA (Health Insurance Portability and Accountability Act)
compliant
9. Tracks and logs all searches for internal audit
Ref: www.softsol.com
Insurance Fraud Detection with Big Data & Search
Discover Insurance Fraud in Real-Time. At Your Fingertips.
This custom-built insurance fraud detection application focuses on delivering:

Powerful and scalable big data platform: processes structured and unstructured data to
analyze and detect suspicious patterns

Affordable, secure open source Hadoop1 architecture: for high-performing content
processing and indexing power combined with increased flexibility and cost reduction

Predictive analytics: compare statistical patterns against previously known fraud schemes
to find fraud indicators and create red flag alerts

Intuitive, real-time dashboard: compiles and presents results from multiple data sources
graphically in real-time, for immediate trend spotting

Advanced faceted search and query suggestions: drill down to individual billing details
and save time with auto-suggestions for common requests or trends

No SQL knowledge required: investigators with no technical background can analyze the
entire data set using a familiar search interface
BENEFITS
1. Immediate ROI2 through a big data powered fraud detection application
2. Increased accuracy, speed, and agility with a predictive analytics and machine learning
3. Reduced reliance on business analysts and SQL knowledge
4. Timely legal case development with red flag alerting feature and direct access to evidence of
fraud
1
Apache Hadoop is a collection of open-source software utilities that facilitate using a network of many computers
to solve problems involving massive amounts of data and computation.
2
return on investment
RESULTS
By leveraging big data to flatten complex databases, the agency realized immediate ROI within a
few months. Ability to analyze 10+ millions of claims, 100+ millions of bill line details, and
related records to compute key fraud indicators and create "red flag" data sets for suspicious
activities rather than just conducting a statistical sampling
Ability to export billing scans and compile evidence to prosecute $100+ million in fraud
Kudos from judges as evidence is delivered in minutes, compared to the industry's average of
three days
Ref: www.searchtechnologies.com/insurance-fraud-detection-solution