RiskShield –
Intelligent Claim Evaluation (ICE)

Insurance companies around the world today face the problem of how to deal with insurance fraud appropriately. Different targets may be contradictory within the company itself and are difficult to reconcile: lowering the costs of claims and processing them (claims department) on the one hand and new customer acquisitions as well as improving the quality of service on the other (sales department).

RiskShield is the software solution for intelligent claim evaluation. As a rule-based expert system, RiskShield automatically assesses the fraud risk of a reported insurance claim. RiskShield works similar to a human expert: The fraud risk is classified on the basis of the long-standing experience of human fraud experts. The system takes both fraud as well as non-fraud indicators into account.

RiskShield decision components are used in more than 25 insurance portfolios in Europe and North America for automatic claim evaluation and fraud risk assessment. An insurance claim automatically classified by RiskShield as inconspicuous can be settled faster and more cost-effectively, thus strengthening customer loyalty. The time now available for a detailed investigation of claims classified as unusual can save the companies millions every year.

A wide variety of uses

RiskShield allows insurance companies to intelligently control the processing of claims so that every claim requiring a manual check is assessed by a member of staff with the appropriate qualification. Furthermore, RiskShield helps insurance companies to create transparency in claim assessment since every claim is assessed according to the same criteria.