What EXL's multi-method fraud detection delivers?
- 01<p>Flags outlier providers 3–7 standard deviations from peers</p>
- 02<p>Uncovers double billing across medical and pharmacy claims</p>
- 03<p>Verifies eligibility to stop identity-based fraud early</p>
- 04<p>Delivers case-ready visuals investigators can use immediately</p>
How EXL uncovers hidden fraud
01
<p><strong>Provider scorecards that cut through the noise</strong></p><p>EXL ranks each provider against peers using Z-scores, isolating the billing patterns that fall three to seven standard deviations from the norm. Your investigators start with a short list of high-risk providers instead of combing through every claim. Stronger leads surface faster, and fewer hours go to low-value reviews.</p>
02
<p><strong>Crosswalk analysis connects what others miss</strong></p><p>Medical and pharmacy claims tell different stories when reviewed in isolation, and that's exactly where fraud hides. EXL links both data sets to catch double billing and diagnosis mismatches that single-benefit review can't see. What looks routine on its own often reveals a scheme once connected.</p>
03
<p><strong>A service-first model, not just software</strong></p><p>EXL delivers more than a dashboard. Our certified fraud examiners act as your special investigation unit, or extend the one you already have, supplying prioritized provider lists and case-ready files. Your plan moves from data to action without adding headcount.</p>
Ready to find the fraud others miss? Download the white paper now to see how EXL's five-tool approach builds stronger cases, faster.