July 20, 2017 2:19 pm

What is Claims Segmentation?

The OLSPS Claims Segmentation Solution enables insurers to automatically push claims down the appropriate line of business (segment) based on the probability of a claim being fraudulent. In other words, a low-risk claim can be automatically sent to the insurer’s Fast Track Route, while a high-risk claim can be directly sent to a Special Investigations Unit (SIU).

OLSPS Analytics’ Short Term Claim Segmentation Solution

Implementing the OLSPS Claims Segmentation Solution optimises the insurer’s business processes both by improving the odds of a claim sent to SIU being fraudulent and by reducing/negating assessment costs on low risk claims.

The OLSPS Claims Segmentation Solution works by automatically assigning a risk level at the point of claim registration, and then distributing it to the appropriate processing channel for settlement or further investigation. This solution can be integrated with the insurer’s existing line-of-business systems, and user/assessor intervention is optional.

Furthermore, the OLSPS Claims Segmentation Solution is fully customisable to include particular business rules that are specific to the insurer.

The unique value proposition of the OLSPS Analytics Claims Segmentation Solution

OLSPS Claims Segmentation Solution is deployed on our OLSOLV deployment platform:

Save TimeOur OLSOLV platform cuts down implementation time of Claims Segmentation Solution by as much as 75%
Excellent analytical expertiseWhen deployed on our OLSOLV platform, the OLSPS Claims Segmentation Solution wraps up years of tried and tested industry knowledge and analytical expertise into a simple, user friendly dashboard – no data analysts required.
Cost EffectiveBoth OLSOLV and the OLSPS Claims Segmentation Solution are developed in-house, meaning that we offer the OLSPS Claims Segmentation Solution at a significantly reduced price!
Low riskThe ease of use and deployment, and the affordability, of the OLSPS Claims Segmentation Solution on OLSOLV effectively brings high end predictive analytics to small and medium businesses, or to big business in an easy to implement manner with comparatively low overhead costs.
Affordable to any business sizeThrough behavioural science and key insights, action is taken to ensure sustained progress that enables a competitive advantage through positive transformation of employee qualities and behaviours.
IBM softwareThe OLSPS Claims Segmentation Solution uses SPSS Modeler Server at its core, IBM’s most powerful, industry leading analytical engine, which OLSPS, as a premium IBM business partner, can embed at a greatly reduced price.
Cloud-basedOptionally, there is a Cloud Base Claims Segmentation Solution which can be accessed from anywhere – the perfect solution for companies with setline offices / multiple offices around the country or the world, those moving into the cloud environment or simply those without the hardware readily available.

How OLSPS Analytics implement Claim Segmentation Solutions?

The OLSPS Claims Segmentation Solution is deployed on the in-house OLSPS Analytics OLSOLV Deployment Platform. OLSOLV significantly simplifies the ability of semi-technical end users to run complex and sophisticated predictive solutions. This eliminates the need for a firm to employ in-house specialists.

*Minimum 3 years of historical data is required to implement Claims Segmentation Solution.

claim segmentation solution requires minimum 3 years of historical data

How long does it take to implement Claim Segmentation Solutions?

Using OLSOLV reduces the time it takes to implement a predictive analytics solutions by about 75%.

If a companies data is Model Ready (Clean Data) then OLSPS Analytics will be able to implement our Claim Segmentation Solutions on OLSOLV in as little as 4 Weeks.

If a company’s data is Not Model Ready (Dirty Data) then OLSPS Analytics will be able to clean your company data and prepare it for implementation. The whole data preparation and implementation process can take from 4 to 14 weeks and it includes: data discovery, extraction and integration, data validation, cleaning, checking data integrity, transforming data, feature creation, creation of aggregates or disaggregate, data staging, auditing and publishing.


OLSPS Analytics will do Free Assessment of your Company Data to give you indication of timelines and final solution price

How much would it cost to implement a Claim Segmentation Solution?

The price of a Claim Segmentation Solution will depend on the company size. Company size is identified by number of users and PVU (Processor Value Unit) which is determined by the number of cores your company server has. Each core has 70 PVU.

A Processor Value Unit (PVU) is a unit of measure used to differentiate the licensing of software on distributed processor technologies (defined by Processor Vendor, Brand, Type and Model Number).

Please see factors which identify business size in terms of data below:

Case Study

Santam is South Africa’s largest short-term insurance company. With more than 650 000 policy holders and assets under management of R 17 bn, the company enjoys a market share of more than 22 %. Santam operates in a market where fraudulent activity can account for an estimated 6 to 10 % of all premiums. 

Santam wanted to find a way to improve its service to customers by settling claims faster and keeping premiums low. To achieve this, the company needed to maximise operational efficiency and find smarter ways to combat fraud. Santam worked with us to design a claims segmentation solution based on SPSS predictive analytics software. Our solution needed to integrate seamlessly with the current Santam claims process, and allow for a real-time scoring of each claim with a sub-second response rate.  The solution works on a claim by claim basis.

The solution offered by our team:

  • Enhanced Santam’s ability to detect fraud, foiling a major crime syndicate and saving R 17 m in the first four months of operation.
  • Improved customer service by enabling legitimate claims to be settled within an hour, more than 70 times faster than before.

For more information, you can download the case study, watch the following video or view the presentation: