Fraud Case Management
Optimize Fraud Case Management with Pega BPM
Financial institutions, challenged with fighting fraud and financial crime under enhanced regulatory scrutiny, are seeking greater efficiency, transparency, and agility in their fraud case management programs. Their counterparts in the healthcare industry are similarly challenged. The FBI estimates the cost of healthcare fraud at more than $226 billion, at a time when spiraling healthcare costs have become the subject of national concern.
Leading financial services and healthcare companies have increasingly turned to Pegasystems to help them optimize their fraud case management processes. Pegasystems, the acknowledged leader in business process management (BPM) solutions, has worked closely with the financial services and healthcare industries for nearly three decades. Our financial services software is used in nine of the top ten U.S. banks and seven of the top ten global banks; and our claims processing software and healthcare software solutions are deployed in seven of the top ten insurance companies and four of the top five healthcare payers.
Pega Fraud Case Management: Efficiency, Transparency, and Agility
Leveraging what is widely regarded as the best business process management platform on the market, Pegasystems has developed solutions specifically for the fraud case management challenges faced by today’s financial services and healthcare services organizations. Pegasystems’ Financial Crimes solution and Healthcare Fraud, Waste, and Abuse Management solution bring the power of complex event processing and intelligent automation to fraud case management, enabling earlier detection and more efficient case resolution.
Key features of Pega fraud case management solutions include:
- Integrated alert management that intakes exceptions from multiple disparate alert systems.
- Automated routing of alerts to appropriate investigative units.
- Automated alert prioritization and risk rating.
- Automated case creation, coupled with automated case enrichment based on customer history data.
- Investigator productivity tools including pre-configured case templates, automated correspondence generation, and a case visualization interface that helps to clarify links, relationships, and patterns.
- Real-time generation of an unalterable audit trail.
- Real-time customized reporting.
- Intuitive design and development tools that increase agility by putting business users in charge of the change management process for fraud detection and handling applications, with minimal reliance on IT staff.
Learn more about Pega BPM.