Enquête et fraude

CLAIMS ADMINISTRATION

Claims administration /
Risk and recovery /
Special investigations unit

Special investigations unit

The leader in fraud investigations.

Our special investigations unit uses industry-leading AI tools to quickly address fraud, waste and abuse across all business lines – reducing risk and delivering unmatched cost savings for your program.

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Two men investigating a claim inside a warehouse.

Fraud is complex, but protecting your program doesn’t have to be. Our special investigations unit is a trusted partner, seamlessly integrating with your current program to cut down on fraud, waste and abuse. With advanced AI scoring technology and the world’s richest data set, we quickly spot red flags and strategically intervene to reduce your risk and claim costs – all while ensuring full regulatory compliance. Our field investigations use cutting-edge video technology, smart cameras and image forensics to uncover critical insights, and with viaOne, you’ll always have full visibility into our findings.

98%

client retention rate

85%

of competitors can’t match our low claim costs

3K+

investigative resources nationwide

World-class investigative and fraud scoring expertise.

Technologie d’analyse et de notation des drapeaux rouges

Our state-of-the-art scoring technology uses machine learning to detect fraud indicators. This information is captured in our proprietary case management system throughout the investigation so our experts can monitor trends and make strategic recommendations. And with viaOne, you get 24/7 access to this data as well.

Research intelligence

We work to uncover critical insights through social media investigations, background checks, medical and facility canvassing, skip tracing, criminal, civil and asset checks, and extensive database mining. Plus, our research findings are all documented in real time for you in our powerful information hub, viaOne.

Enquêtes sur le terrain

Whether you need in-person or remote surveillance, our investigation techniques are tailored to each case and use the most advanced video technology, smart cameras and image forensics around. We also conduct in-depth interviews, activity and alive-and-well checks, canvassing and other on-site investigations as needed.

Fraude et conformité réglementaire

We achieve maximum compliance by reviewing suspect and scored claims, red flag analysis, consultancy with examiners, fraud investigations, state fraud submissions and carrier regulatory reporting. Our team stays ahead of legislative changes, ensuring we always stay compliant when detecting and reporting fraud.

Gestion des fournisseurs

Beyond our in-house team of 80+ specialists, we partner with 3,000+ investigators across the U.S. from regional and national providers and certified MBE, WBE and VBE businesses. Our partners are credentialed to meet strict security, insurance and licensing requirements – keeping you and your data protected.

Assurance de la qualité et impact

Using the most sophisticated data analytics tools, we regularly analyze key metrics, trends and benchmarking data to measure the impact of our services and refine our strategy. Our data-driven approach helps us deliver the best possible outcomes, with an average claim cost lower than 85% of industry competitors.