Workers’ Compensation

Insurance Fraud

costs Businesses $30 billion every year

Brief Overview of Aquilla

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Reduces 4-5 weeks of data gathering to just a few minutes

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Automatically manages provider profiles to cut down on administrative work

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Enables companies to investigate a fraud case rather than spend time looking for one

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Lessens the dependency on the IT team by over 80%

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How It Works

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Step 1

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Step 2

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Step 1

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Billing Information

Analyze medical claims and bills across various jurisdictions by using a general view and then drilling down to go deeper into more specific layers of the data. Examine billing details of a specific claim from a selection of millions of claims records in mere seconds. Identify top providers across various geographic areas and their billing patterns based on the services they provide.

Reports

Generate canned as well as adhoc reports rapidly by slicing and dicing the data based on various attributes of claims and bills. Get a deeper insight into the data by getting answers to the business questions/problems by querying the data and generating reports that facilitate fraud investigations. Build your own use cases without help from IT.

Claims Analytics

Analyze potential fraudulent claims and bills based on the fraud indicators identified by the built-in use cases such as excessive services, unbundling, referrals, doubling billing, treatment not rendered etc. Saves a lot of time for the user by analyzing large volumes of data and presenting the potential fraudulent claims by classifying them in various categories of fraud.

Provider Profile

Get a 360-degree view of a provider profile and score them based on their billing history, overall standing, and credibility in worker’s compensation industry and their relationship with the insurance agency. Keep the fraudsters on the watch list thus preventing the release of payment to the providers who are suspended by law from worker’s compensation system due to indictment or conviction.

Link Analysis

Presents the relationships between various entities in a worker’s compensation claim in a graphical way. Efficiently identifies the relationship of fraudsters with other providers by associating them via common entities or relations. This feature of network visualization can be used as part of a wider fraud management effort to increase efficiency and effectiveness.

Why Aquilla?

The present technology marketplace for workers’ compensation insurance fraud detection is meager. Although some big technology players provide solutions in this niche, their products don’t offer the feature-rich, plug-and-play functionality that Aquilla offers. Companies that source fraud detection solutions from software giants often integrate tools and further customize those solutions.

Aquilla is a proprietary solution purpose-designed to solve the key problems in proactively identifying fraud. Unlike older solutions in this niche, Aquilla incorporates new technologies that drive meaningful automation and deliver better outcomes.

Key Benefits

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Catch hard and soft fraud with 20 different use cases

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Close fraud cases 100 times faster

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Improve operational efficiency by yearly 90%

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Save 48 hours of fraud detection effort each week

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Close fraud cases 100 times faster

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Improve operational efficiency by yearly 90%

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Did You Now?

More than one in 10 small business owners are concerned an employee will fake an injury or illness to misuse workers’ compensation benefits.

$7.2B

Annual workers compensation insurance fraud amount is estimated by The National Insurance Crime Bureau (NICB)

1/10

Small business owners are concerned an employee will fake an injury or illness to misuse workers’ compensation benefits.

94%

American businesses carrying workers’ compensation insurance and fraudulent claims deliver a significant economic blow

Testimonials

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Support

Here is how we support you

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Let's create something extraordinary

Together

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