Fraud, Waste & Abuse
LISA integrates an advanced system for detecting anomalies and deviations in claims. We use Artificial Intelligence, Machine Learning, and an expert framework of rules and alerts designed to proactively identify and mitigate risks during the settlement process.
Our technology analyzes data and patterns to flag suspicious or inappropriate activity during and after the process, enabling your team to act quickly and accurately.
With LISA you will be able to detect false documentation, payment deviations or accumulation, suspicious fraudulent behavior, as well as access our predictive algorithm created with Graphs and Machine Learning.
Predictive Model
We understand abuse as those incidents whose high frequency is not justified; with LISA's advanced analytics, you can detect this type of behavior.
Detection of falsified documentation
We develop several techniques to detect altered documentation or images through metadata analysis, grayscale, georeferencing, and template validation.
Waste detection
We understand waste as claims that are incorrectly settled, either for a higher amount or that do not meet the policy conditions. With LISA's advanced analytics, you can detect these types of anomalies.
Validation with external sources
LISA specializes in developing web scraping tools to perform validations and increase control over your processes, such as:
- Tax services to validate invoices.
- National registry of health providers
- Ecommerce sites and many more.
Abuse detection
All our years of experience and millions of claims processed inform the creation of predictive fraud detection models using databases, graphs, and machine learning. Stopping fraud before payment is now possible!
Our numbers are the best proof of our impact
60 - 90%
Straight Through Processing
+ 40%
Improved Utility
< 80%
Settlement Times
+ 2M
Claims Processed
⬆30%
Customer Satisfaction
+ 20
Implemented Solutions