Ra7solution 2010

FIGHTING INSURANCE AND FINANCIAL FRAUD MORE EFFECTIVELY THAN EVER BEFORE

Introducing Nemesysco’s RA7

About Nemesysco

One technology, numerous uses:

RA7 solution - overview

RA7 solution - overview

• 1 integrated solution• 1 day agent’s or 5 days front line investigator training!

• 100 % calls coverage• Streamline & standardize investigation procedures

• Unbiased. Informing. Precise.

RA7 solution

RA7 can be used for:• Claim processing• Underwriting & Risk assessment

• Loan requests & credit cards• Periodic “over-the-phone” tests

RA7 solution - Limitations

•Not all fraud will be detected.•Not all cases will be proved.•Not all customers will be happy.

… but most of the time it will.

RA7 solution – Limitations explained…

RA7 solution – Limitations explained…

(1)To have a significant effect on your bottom line.

(2)To improve customer service

(3)To change as little as possible current procedures

RA7 – Our mission:

RA7 – Our mission:

• Using RA7 solution we will achieve the following:• Monitor all incoming claim calls for fraud attempts

increase overall Fraud Detection Rate

• Add 2nd level of customer handling

“Assist” fraudsters withdraw their claims

• Provide a faster payout for claims that are risk-free

Faster and better service for legitimate customers

• Customer awareness to the “Risk” taken when trying to commit fraud

reduce number of fraudulent claims

RA7 solution – One System

• The contact center – Today:• No procedure for risk assessment, no point in training• The only place in touch with 100% of the calls

• Claim Managers / Loss adjustors• Oversees all cases, must reach decisions fast• Lacking tools to really detect fraud –tools are biased by definition

• Investigators• Limited and expensive resources• Poor start point with little useful data• Have to filter through high % of genuine claims

Streamlined process

5-10 Minutes

1 - 5 Minutes

Fast -track payment

FormalInvestigation

30 minutes (adjusting the claim)

Streamlined process

• 100% of the calls are monitored and analyzed• Operators follow a special “conversation script”• RA7 automatically determines RISK LEVEL for each of the calls• Trained operators can detect and deter fraud at the initial

interaction

Streamlined process

• Claim managers / Loss adjustors receive clear reports of all claims

• Easily manage and assign high-risk cases to investigation• Can conduct a follow-up interview or authorize the payment

Streamlined process

• Handle only high risk claims – better chance for defeat• Save time on the field - conduct more phone investigations• Can use other professional tools by Nemesysco

Fraud awareness,a real necessity…

A survey conducted in Pennsylvania in 2008 revealed the following:1.Knowledge about insurance fraud itself is minimal. Only one in six

respondents was knowledgeable about how insurance fraud is classified and defined. Even fewer understand that insurance fraud is a felony.

2.Many do not believe insurance fraud is a serious crime. Only 12% categorized insurance fraud as one of the most serious types of crimes and only 25% said they were likely to report someone who was committing it.

3.Nearly 70% stated strongly they would never consider committing insurance fraud. But, this leaves 30% who might consider committing the crime.

4.Almost all surveyed believe that insurance fraud perpetrators rarely get caught. An extremely low number (3%) reported “strongly believing” those who commit insurance fraud will be discovered and apprehended.

RA7 project process

• Adopting the new concept & technology• The “fraud prevention stick” and “Fast track carrot”• Becoming proactive in fraud detection• P.R. and Legal concerns

• Creating scripts• Understand in-house investigators needs• Covering all types of relevant claims

• Implementing RA7• IT and installation• Training & Mentoring• Follow-up and support

WE LOOK FORWARD SERVING YOU TOO!