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Risk management for social services from IBM
Executive summary Department view Technical details
The goal
Speed eligibility determination, reduce risk
Thirty percent of disability applications are clearly disability cases. Five percent of claims volume can drive 50 percent of program costs. Yet all applications go through the same process. Identifying eligible claims cases up front saves time and resources, and provides services and benefits to those most in need. No matter the social segment, the goal is the same—to make the right decision as early as possible in the process. Risk management for social services from IBM can help.

The advantage
Advanced technology, leading practices
Our risk management solution is just one component in a broad portfolio of tools designed to help organizations take advantage of global best practices in social programs. We have:
  • Uniquely qualified and experienced consultants who are PhDs, distinguished engineers, statisticians, mathematicians, actuaries, public policy analysts, and former federal fraud inspectors and auditors.
  • Extensive experience in developing solutions that deploy early-warning analytics to detect potential fraud and abuse, allowing companies to respond to problems faster and more cost-effectively.
  • One of the largest consultancy practices to supply solutions to social services and social security clients, in over 160 countries around the world.

The benefits
Extensive predictive modeling capabilities
Using predictive modeling, risk management for social services from IBM can help your agency improve service and:
  • Detect and prevent deliberate attempts to mislead agencies and programs using false identity.
  • Support major business processes by increasing investigator and auditor productivity and effectiveness.
  • Make data anonymous for citizen privacy, regulatory compliance and list sharing among internal and external data sources.
  • Establish real-time links between data from agencies that dispense benefits with those that contain workers' earnings, as well as information from other data sources.
  • Leverage information and existing environments with minimal new investment in hardware, software and business processes.
  • Compare your data with other organizations to cross-reference identity records with lists of individuals known to have submitted false claims.
  • Share only the data that is pertinent to your specific application.

The approach
A proven risk management solution
Since 1994, IBM has helped many clients change or enhance the technology and business processes they use to prevent improper payments. This experience covers both private and public sector organizations, spanning multiple industries. Our risk management solution has already seen proven results.

One such project involved applying data analytics to a population of 12.4 million disabled citizens receiving benefit payments. Recipients were brought in annually for medical evaluations to determine if benefits should continue. The data analytics work resulted in eliminating a backlog of 1.7 million evaluations and saved the agency US$1 billion over five years as a result of eliminating unnecessary evaluations and related administrative costs.

The financial advantage
Reap substantial benefits
Risk management for social services from IBM can help reduce the cost of managing claims and provide a return on your investment. It can also help you:
  • Reduce administrative costs associated with evaluating applications.
  • Free up staff to focus on more complex cases while expediting simple claims to a separate, less expensive process.
  • Prevent improper payments and save agency funds by identifying and reducing fraud.

Next steps
 
Questions about this solution? Contact an IBM government specialist.