Fraud & Risk Analytics

Identifying and monitoring fraud and non-compliance is critical for every organization. In addition to monetary loss, your organization’s reputation and trust are at risk. Data science and machine learning solutions can help companies stay ahead of ever-evolving fraud risks to proactively mitigate active threats.

We have deep experience partnering with fraud, risk, compliance, and threat detection departments. We use creative data science techniques to build and deploy impactful analytic solutions to arm front line investigators and auditors.

We have built fraud and risk solutions in:

• Contract and procurement fraud
• Healthcare provider, pharmacy, and payment fraud
• Insurance claims fraud
• Financial services fraud and non-compliance
• Tax fraud and non-compliance
• E-commerce transactions fraud
• Cyber and insider threat

RADR Platform

We created RADR (Risk Assessment Data Repository) as a risk analytics platform for front line investigators and auditors. RADR uncovers previously unseen risks, visualizes connections between risky entities, and monitors anomalous behaviors.

Case Studies

Targeting Questionable Contracts to Detect Fraud, Waste, and Abuse

The U.S. Postal Service manages billions of dollars of assets from contracts to buildings to machinery. To be more proactive in fraud and risk analysis, the agency partnered with Elder Research to develop and deploy analytics-driven fraud detection solutions to identify and prioritize questionable entities for investigation.

Results: The fraud solution generated over $11  million in recoveries, restitution, and cost avoidance in the first year and has since contributed to $920 million in findings and revenue recovery.

Improving Workers’ Compensation Provider Fraud Detection

Our client, a national Workers’ Compensation Insurance Program, handles almost 250,000 injury claims per year by claimants who are seeking compensation for services rendered by tens of thousands of medical providers. We designed and deployed an automated fraud detection and visualization solution to improve the efficiency of fraud investigations by prioritizing high-risk cases.

Results: Investigations and forensic analyses that took hours can now be completed in minutes, making the most efficient use of limited and valuable resources.

Reducing Service Provider and Warranty Fraud

The warranty department for an industry-leading computer technology provider needed to reduce return rates and proactively identify warranty fraud and claims anomalies.

Results: We designed, built, and deployed an automated fraud detection solution credited with saving over $67 million in service provider and warranty fraud.