How Mody Data Solutions Identified Over $1 Billion of Fraud and Saved a Fortune 100 Insurance Company $250 Million

Insurance fraud is at least an $80 billion problem.  How well are you protected?

Analytics meets Expertise

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Mody Data Solutions was founded based on experience creating amazing value by combining business expertise with the latest technology.  We have designed cutting edge predictive algorithms and technology that comprise our fraud detection system.  The core of our ability to detect fraud is our expertise in Analytics and Fraud. We incorporate fraud schemes, red flags, industry trends, client fraud cases and fraud hotline tips into our detection algorithms to identify application and claim fraud.  

Our client received a tip on their fraud hotline.  This tip allowed us to identify a pattern and create algorithms that led to us identifying $1.1 billion of application fraud.  


Fraud Detection Challenges

The State of Insurance Fraud Technology Report by the Coalition Against Insurance Fraud reported approximately 50% of their respondents reported challenges employing anti-fraud technology due to limited resources.

Of the companies that use anti-fraud technology only 40% use predictive modelling. 

Fraud Detection companies are selling software solutions that require a lengthy software implementation project and consultants to implement the system, design data models and train your company how to use the system and start finding fraud.  This requires a huge dedication in effort and time and effort from both companies, except the software vendor is not accountable for the results.  


Providing Value from Day 1

Through Service, Not IT

 

When going with other fraud detection companies it is managed as an IT project.  The vendor spends the first 6 to 9 months of the engagement negotiating with IT Security to connect with the data (Only 64% of IT projects meet their goals).  Before you know it a year has passed and your company hasn't saved any money.

Mody Data Solutions fraud detection works as a service where our fraud experts come onsite day 1 to begin detecting fraud for you.    We work with the data in whatever format it can be most easily provided whether it is stored locally on a desktop or in a data lake. No training need, we manage the fraud detection efforts for your company, so your company can focus on what it does best.


Investigation Tools

 

Data Visualization among several other tools we use is vital in our fraud fighting efforts.  It allows us to tell a compelling story and take our fraud detection results to another level.  We are able to vet results and examine patterns from different perspectives with unprecedented speed.  

Our data visualization tool was crucial in identifying the scope of the $1.1 billion fraud and the root causes of the fraud.


The Human Element

 

We vet the results and meet directly with our investigative liaisons to walk them through our results and what suspicious fraud leads need to be investigated.  We took care of the analytics they took care of the investigation (with our support).

Mody Data Solutions worked with the client's investigators to provide them sufficient information to support the investigations they start based on fraud detection results.  This allows them to begin an investigation with a clear picture of the breadth and severity of the suspicion without having to worry about the data science and technology that led to the fraud leads.


Partnership and Aligned Incentives

 

Mody Data Solutions works with clients as partners protecting them and their customers.  We stand by our work and are rewarded solely based on our performance.  To ensure our performance is best in class, we invest resources in constantly improving our fraud detection algorithms and technology.

  

WHAT COULD YOUR COMPANY DONE WITH THE FUNDS LOST DUE TO FRAUD?

HOW OFTEN IS FRAUD GOING UNDETECTED AT YOUR COMPANY?