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Prescribing Digital Workflows to Mitigate Fraud Risk

Technologies

This Fortune 50 pharmaceutical powerhouse struggled to identify and tackle fraud with their external partners, tethering employees to manual, paper-based processes and workflows. They needed a user-centric solution to streamline fraud management processes and empower fraud investigators to put a lot of lost time—and potential recovery—back on the table.

To empower the Fraud Team to proactively detect and manage fraud cases, we immersed ourselves in their world, understanding their pain points and aspirations. We collaborated to concept their future-state vision through persona development, journey mapping and extensive workshops. By leveraging the power of ServiceNow to streamline critical tasks and provide access to crucial data, the team was fully equipped to track and fight fraud efficiently—and with confidence.

Veracity re-engineered this company’s fraud processes and workflows, streamlining processes from 52 steps to 11, and delivering digital solutions to help their team proactively manage and identify fraud.

Standardizing & Automating Tasks, Processes & Workflows

Through analysis of their current state fraud processes, Veracity uncovered a 52-step process involving back and forth emails, mountains of paperwork and little to no data access, making it frustrating for teammates to efficiently manage and track cases. By streamlining their procedures and automating 85% of their workflow, we reimagined an experience that would reduce the fraud management process down to 11 simple steps, freeing up the team to do what they do best—chasing financial recovery.

Proactive Diversion Targeting To Identify Potential Fraud

Many fraud cases came from self-identifying hospitals, but investigators had little ability to proactively generate leads or identify fraud in other areas. To assist investigators in better identifying potential fraud, Veracity designed a predictive targeting dashboard to flag unusual activity and allow the team to target new cases, recover more money and track the recovery progress more efficiently. Veracity designed a lead generation experience that runs automated data queries against key fraud parameters, allowing investigators to recognize potential instances of fraud, identify trends like unusual activity and flag for review. Additionally, we created tools like manual query and comparative analysis allowing the team to have better dominion over the data to explore anomalies or potential indications of fraud.
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Project Outcomes

51
Steps In Case Management Process Streamlined & Digitzed Down To 11 Steps
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85
of previous process flow automated
1
single source of data for fraud investigations and case management

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