The RA5 solution

The RA5 solution is a combination of tools and investigation techniques designed to tackle most of the fraud attempts your organization is facing, with two missions in mind:

To significantly increase the bottom line by minimizing unrightfully paid claims, while improving your legitimate customers’ service and support at their time of need.

Our aim is to achieve both missions with minimal disruption to the process flow and policies currently in place in your organization. The RA5 systems use the LVA voice analysis technology as a primary tool in its evaluation process.

RA5 tools are not “lie-detectors”. The RA5 system was designed to offer a balanced approach between your customers’ rights to receive fair and quick service at their time of need, with your organizational requirements for proper assessment and evaluation of relevant information.

RA5 tools are made to assist and speed your investigative processes, providing the investigator with a tool that can highlight problematic areas in the claimant’s story. The solution allows the investigator to focus on the problematic cases, and if these are indeed identified as High-Risk, to use other formal investigation techniques to counter the illegal fraudulent attempt.

RA5 process aims to differentiate between 3 types of claims:

  • Genuine claims – Low risk claims, in which the material issues and material details are correct and are not exaggerated. These claims should be forwarded to the “Fast Track” processing.
  • Medium Risk Claims – In this type of claims, the material insurance case correct but are most likely suffering from some inaccurate or inflated details. These claims are forwarded to Loss Adjusting process using additional tools, in order to try and minimize the claim to its rightful size.
  • High Risk claims – In these cases the basic insurance case is suspected and should be further investigated. Such claims will be forwarded to the “Special Investigation Unit” for a second interview.

The fast track processing is an important part of the RA5 solution. By quickly releasing the majority of claims which are genuine, your rightfully deserved customers will receive a better service than would otherwise be possible, allowing the allocation of more investigation resources where needed.

For more information, please contact us: bizdev@nemesysco.com