Blogs

Healthcare Insurance: Looking Back at 2020

Healthcare Insurance: Looking Back at 2020

Finance Financial Services Fraud Detection Telehealth
Reflecting on the biggest telehealth fraud in DOJ history (2020) & how to confidently sidestep it in 2021 and beyond.
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Top 3 Fraud Trends in Banking Industry: Looking Back at 2020

Top 3 Fraud Trends in Banking Industry: Looking Back at 2020

Financial Services Fraud Detection
The pandemic in 2020 has exacerbated the problem of fraud and abuse in the banking industry. This article identifies the specific fraud trends that banks had to look out for in 2020, helping you to prepare for future risk.
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The New Face of Healthcare Payer Fraud: Tsunami or Passing Trend?

The New Face of Healthcare Payer Fraud: Tsunami or Passing Trend?

Finance Fraud Detection Healthcare Telehealth
The advent of Telehealth and Telemedicine have resulted in a proliferation of these instances. How do we deal with this altered environment? How do we stay ahead of the curve of emerging new fraud strategies?
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The Ascent Of Citizen Data Scientists: Empower Your Analysts

The Ascent Of Citizen Data Scientists: Empower Your Analysts

Data Science Efficiency improvement Other
More and more businesses have adopted AI and data-driven methods to drive better business decisions. NEMESIS provides cutting edge technologies and ready-to-use solutions to empower your analysts to citizen data scientists.
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Reduce Loan Delinquencies By Leveraging Machine Learning

Reduce Loan Delinquencies By Leveraging Machine Learning

AI Data Science
After the financial meltdown of the last decade, many lenders have found themselves in a tough situation where they cannot use the conventional underwriting guidelines to identify enough “good borrowers” to whom they can lend money. AI & ML are changing the way credit has been assessed and is allowing vendors to look for new credit approval metrics such as purchasing history, bank data, or social media habits. Harnessing this technology to better forecast defaults.
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Porsche Westlake’s Services Director, Sam Abregel, Addresses Auto Warranty Fraud

Porsche Westlake’s Services Director, Sam Abregel, Addresses Auto Warranty Fraud

Fraud Detection Growth Opportunities Insurance Other
We sat down with Porsche Westlake’s Service Director, Sam Abregel, to address 8 categories of warranty fraud to watch out for. Given the vast amount of transaction data and the presence of anomalous patterns indicating fraudulent activity in these categories, there is a huge opportunity to harness predictive analytics and machine learning models.
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Artificial Intelligence and Machine Learning Help Detect, Predict and Prevent Fraud

Artificial Intelligence and Machine Learning Help Detect, Predict and Prevent Fraud

AI Efficiency improvement Fraud Detection Healthcare IT
Fraud has been causing rising challenges for businesses. Over 72% of businesses cite fraud as a growing concern, and about 63% of businesses report the same or higher levels of fraudulent losses over the past 12 months according to a report by Experian Global. The challenge is not just about preventing fraud, but figuring out how to predict it before it happens, so it can be prevented from happening at all. But before we make strategies to combat fraud, it’s important to understand the barriers associated with fraud detection strategies.
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Understanding Healthcare Claims & Fraud: An Unfortunate Certainty

Understanding Healthcare Claims & Fraud: An Unfortunate Certainty

AI Healthcare Insurance
Healthcare claims are an inviting and alluring target for fraudsters due to their huge monetary value. In 2017 alone, HHS and DoJ recovered around 2.5 Billion Dollars in claims fraud. And that is just one year. The challenges facing healthcare payers are manifold as they try to tackle the rampant and growing problem of claims fraud. From high dollar impact, billing compliances to the high cost of manual investigations, the health care providers are sweating. So what exactly is Healthcare Fraud? And how can we try to mitigate them using technology?
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Savvy CFOs Are Using Machine Learning To Detect Fraud Schemes

Savvy CFOs Are Using Machine Learning To Detect Fraud Schemes

Finance Machine Learning
With the burgeoning growth of electronic financial transactions and their relative anonymity, sophisticated fraud schemes have exploded in the last 5 years, as reported by the FBI and leading publications such as The Wall Street Journal, Forbes, and the New York Times. As reported by CNBC, over 16 Billion dollars was lost to identity theft fraud alone. However, savvy CFOs are using Machine Learning to detect these fraud schemes and thwart these criminals.
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Huge Payoff Is Possible By Identifying Fraud Schemes

Huge Payoff Is Possible By Identifying Fraud Schemes

Fraud Detection Machine Learning
We’re living in an era of extreme automation, high transaction volumes, and a highly connected world where it’s so virtually easy for fraudulent transactions to hit any business. To protect your business from fraud schemes and bad actors before they can cause significant damage, detecting fraud patterns is essential and a huge payoff when done in real-time.
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Supercharging Your Financial Control & Fraud Detection Initiatives; The Role Of Data Quality

Supercharging Your Financial Control & Fraud Detection Initiatives; The Role Of Data Quality

Data Science Efficiency improvement Finance Fraud Detection Machine Learning
Effective fraud detection and financial control initiatives leverage advanced analytics and machine learning techniques to derive valuable and actionable information for managers. Today’s enterprises churn out humongous volumes of data but are still unable to use most of that data in its raw form. The task of acquiring, cleansing, shaping, and bending the raw operational data for analytics or other business purposes is known as data preparation.
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Why Anomaly Detection is Important

Why Anomaly Detection is Important

Anomaly Detection Financial Services Healthcare Insurance IT Machine Learning
With data driving most business transactions, it is essential to analyze and interpret patterns in behavior correctly. NEMESIS, an anomaly detection tool powered by machine learning, can detect and predict against abnormal behaviors in data that signal threats of risk and fraud.
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The Case For Continuous Monitoring Of Financial Transactions

The Case For Continuous Monitoring Of Financial Transactions

Financial Services Fraud Detection Growth Opportunities Machine Learning
Continuous monitoring (CM) and continuous auditing (CA) systems provide real-time monitoring and reporting of business processes, activities, and transactions. This could largely benefit CEOs, COOs, and board members who are concerned with the risking risk, regulation, and costs in their organization.
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How Artificial Intelligence Can Help Internal Auditing

How Artificial Intelligence Can Help Internal Auditing

Finance IT Operation Other
If you work in a company or an organization that wants to improve the effectiveness of risk management and governance...
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Using AI To Control Employee Expense Fraud

Using AI To Control Employee Expense Fraud

AI Finance Fraud Detection Operation
Reimbursable employee expenses are a significant cost for most businesses, and unfortunately, they are often a source of fraud by unscrupulous employees. To combat this, businesses typically rely on auditing employee expense reports manually. As this is a tedious and very labor-intensive process, usually only 10% of all the receipts get audited. Thus businesses have an increased risk of expense report fraud going undetected.
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Anomaly Detection – A Machine Learning Solution To Eliminate Risk

Anomaly Detection – A Machine Learning Solution To Eliminate Risk

AI Anomaly Detection Fraud Detection Growth Opportunities Machine Learning
With the rapid growth of the internet and the IoT and the resultant digital transformation of the world we live in, there is an explosion of data that is being generated, collected, and stored. There is data available for “normal” transactions, as well as for the fraudulent of interest to a company. If one could successfully analyze this data and gain meaningful insights and draw conclusions from it, it would be possible to use that insight for reducing the threats and risks against organizations.
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Leveraging Digital Technology To Unearth FinTech Fraud

Leveraging Digital Technology To Unearth FinTech Fraud

Finance Financial Services Fraud Detection Growth Opportunities Insurance
As the volume of online transactions continues to grow exponentially, there is a new quest for enterprises to start new channels of business, gain more online presence, retain existing revenue streams, and stay relevant to current technology. Many organizations are unable to detect patterns related to Fintech fraud because they are stuck doing traditional rule-based approaches. Emerging modern technologies, like NEMESIS, use the power of AI and machine learning to fight against financial fraud.
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Top 5 Fraud Cases Of 2019: Looking Back

Top 5 Fraud Cases Of 2019: Looking Back

Finance Financial Services Fraud Detection Insurance Operation
Fraud isn’t something new, but it is becoming more complex and sophisticated. From bribing exam administrators to CFOs conducting unethical transactions, these five fraud cases were some of the most shocking for 2019.
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