The company faced three main challenges: identifying the most-likely-to-purchase customers, maximizing the value of its customer data, and optimizing marketing return on investment. Traditional marketing campaigns were casting a wide net, resulting in low returns and wasted resources. The ultimate goal was to improve revenue growth and increase retention rates among existing policyholders by leveraging existing policyholder data for new revenue opportunities and achieving the greatest benefit from cross-sell and up-sell efforts.

Like many carriers, this company struggled with managing inspection resources for the greatest return on investment. It lacked the ability to specifically identify those properties most in need of inspection at the time of policy renewal. Instead, this carrier conducted selective inspections of properties in high hazard areas; a costly and time intensive method with little to no perceivable impact on actionable rates. As losses continued to mount, alarms were raised across the enterprise. The call went out for a cost-effective solution that would cause minimal disruption to the current process while significantly increasing actionable discovery rates, thereby reducing losses.

As a start-up collection agency, EAS is challenged with competing against entrenched competition staffed by experts in collecting student loans. In order to jump-start growth, the company brought in loan industry veteran Don Taylor as president to lead the efforts to insure the firm’s ability to compete. Upon joining the company, Taylor realized that many of his agents had limited experience in collections and most had no experience in student loan collections. Furthermore, the agency had yet to invest in many critical resources, such as skip tracing tools, on which other firms rely on. Taylor was determined to find a way for EAS to discover and exploit a competitive advantage while implementing a lean, highly profitable operating structure that would protect margins.

In the face of rising medical claims costs, payers are looking to improve member engagement in their own health and minimize unnecessary utilization of the health care system. However, the Affordable Care Act (ACA) and the creation of Health Insurance Exchanges have led to millions of consumers accessing health benefits for the first time and possessing little or no historical, clinical or claims data. The lack of medical history makes risk modeling and effective member engagement particularly difficult. This Case Study seeks to answer the question, “Can socioeconomic data be used to help predict member health risk and inform improved member engagement strategies?” EveryMove (and their payer clients) need a comprehensive picture to determine population health risk and the ability to precisely target high-risk members with the appropriate engagement incentives. Always seeking to optimize the timing and accuracy of its member interventions, EveryMove places an extremely high value on predictive intelligence that provides insight into the health status and potential health risks of individuals. With so many new consumers lacking traditional data, like claims and clinical records, EveryMove chose to test and measure the ability of non-medical, socioeconomic data to fill in major gaps in member health profiles, and to accurately predict health risks.

Discerning the validity of prescriptions today is a complicated process made more complex by a number of factors, including ongoing prescriber regulatory challenges impacting daily pharmacy operations, varying payer requirements causing discrepancies, licensure inconsistencies across prescribers, intricate drug diversion schemes, and more stringent claims audits by the Centers for Medicare & Medicaid Services. Together, these issues make validating every prescription an operational challenge and risk, with consequences ranging from inappropriate reimbursement to tens of millions of dollars in fines for record-keeping, dispensing, and narcotics violations. The Drug Enforcement Administration (DEA) using their own federal data and data from state-level licensing boards to determine prescriptive authority is causing an even more complicated regulatory environment for retailers. Add to this the increased scrutiny from the media and others, and it is clear that retail pharmacies need a reliable solution—one that incorporates current information about prescribers and enables alignment with all relevant regulations in order to verify prescriber information prior to billing and dispensation. Unfortunately, many pharmacies are working with systems that were not designed for the complexity of today’s prescription claims process, often ingesting and matching data and technology components that are not designed to work together efficiently. The result is a workflow that is far from conducive to supporting pharmacists’ primary roles—patient service and safety.

HealthSmart, the nation’s largest independent administrator of health plans for self-funded employers, places a major emphasis on leveraging analytics to achieve transparency in order to ensure health care quality and gain control over costs.

With ever-tightening reimbursements, providers around the country are competing for patient volume to sustain their organizations. Through physician outreach programs, one health care provider attempts to attract referrals from other providers in the same service area. Physician outreach programs can be inefficient and wasteful if they aren’t targeting the right kind of practitioners. This can waste time for the physician liaison, prospective referring physician and lead to wasteful spending for ineffective outreach. Without data to support and focus outreach efforts, Roswell Park had an insufficient view of the practitioners who were seeing and treating patients they wanted to attract. This lack of insight created operational waste and inefficiency. Physician liaisons couldn’t differentiate between an ideal practitioner relationship and a less essential one. When all practitioners looked the same from an outreach standpoint, it was difficult to prioritize time and outreach expenditures. Roswell Park recognized a need for data to help them prioritize their physician outreach efforts and ensure they were targeting the most appropriate practitioners.

Recent changes and pressures caused by health care reform have had a significant impact on LSOs and the market. Individual health care providers are consolidating, forming groups and merging into IDNs as a way to save costs. As a result, LSOs have been actively looking for opportunities to be more effective and efficient with product promotion. LSOs have been forced to shift from a traditional rep-to-provider selling model to an account-based, B2B selling model that focuses on value, partnerships and influence. In preparation for the launch of a new product, a large pharma company hired Rivermark to identify the key U.S. scientific and clinical thought leaders who educate their peers and who impact treatment and product choice in the type 2 diabetes market. Additionally, the company wanted to know as much as possible about the role and function of major IDNs in health care decision-making for type 2 diabetes.

With so many suppliers to vet worldwide, the company had relied on a vendor to conduct research and due diligence at the onboarding stage. However, it proved to be a frustrating, inefficient process: It often took the vendor as long as 6-8 weeks to deliver a report – which often meant the client company had to either delay onboarding a desired supplier, or greenlight it without knowing the risks. Additionally, these reports were not customizable, and provided too much unneeded detail. The company had very specific criteria they were looking for, yet it was often buried in dense report narratives. This substantially slowed approvals.

As LV=’s commercial property insurance business continues to grow, and with the rise in flooding and one-off weather events, the insurer wanted to arm its underwriting teams with the best technology to help them quickly and accurately assess the flood risk associated with any given property. By empowering its teams with the tools and insight to assess flood risk at the building level, at the point-of sale, LV= ensures its business continues to be profitable and is not exposed to unnecessary risk. The online tool uses state-of-the-art street view technology and flood mapping to show highly accurate images of properties and their proximity to flood plains and previous flood activity.

MONETA Money Bank has been using LexisNexis Bridger Insight XG for sanctions screening since 2012. In 2016, following a separation from its previous parent company, MONETA began using the Bridger Insight Enterprise version and LexisNexis WorldCompliance Data. The main challenge was to achieve a favorable price/performance ratio while safely relocating the existing solution into local infrastructure. The initial use of WorldCompliance Data led to a significant surge in alerts (around 16K), which needed to be cleared. Additionally, there was an increase in daily portfolio screening and SWIFT screening. After clearing the alert surge and retuning the tool, there was a 10% increase in customer onboarding and SWIFT payments screening, with new matches in PEP batch screening due to the change of data source.

The recent tightening of regulatory screening in Turkey has affected a wide variety of business areas, especially in the IT and data management sector. In order to comply with new KYC guidelines, iyzico needed to build out their practices and to develop sophisticated compliance procedures in line with Turkish regulations. iyzico started using LexisNexis® WorldComplianceTM Online Search Tool in June 2017 to fulfill its compliance responsibilities. By employing LexisNexis® Risk Solutions’ integrated technology and expansive data resources, iyzico has access to one of the industry’s most extensive databases that provides information on individuals and organizations in more than 50 risk categories, including Foreign Officials, Sanctions and State Owned Enterprises. iyzico is now able to manually screen prospective clients against global sanctions lists and perform enhanced due diligence with more than 2.5 million profiles that are updated daily by a global network of analysts.

Risk management is a core competence for the compliance arm of Volkswagen Financial Services AG. The team is focused on the development and implementation of appropriate methods, processes, and systems for all substantial risk categories. The headquarter in Germany employs nine people on their compliance team. Volkswagen Financial Services AG has used LexisNexis® WorldComplianceTM Data since 2007, which is utilized in 16 countries. The solution enables organizations to batch and real-time screen large customer databases. The company needed a solution to comply with a new law in Germany, the Geldwäschegesetz (German AML Act), regarding the screening of PEPs. The German AML Act established a requirement on businesses located in Germany to screen for PEPs. For a global business like Volkswagen Financial Services AG, the ease of use of multiple licenses was critical for success. Each country has its own AML officer and deputy. The headquarters in Braunschweig sets the guidelines, and the regional offices report back and provide risk analysis to the headquarters. The differences in local requirements are a challenge for a group-wide compliance structure. Although they have a group license for the LexisNexis® WorldComplianceTM Data solution, every branch and subsidiary have to ensure the screening is in compliance with both their local and group regulations.

Police departments in Georgia faced significant delays in processing crash data due to the manual, paper-based system in place before 2009. This lag hindered the ability of law enforcement, local officials, and public safety stakeholders to make timely, data-driven decisions. The LaGrange Police Department, led by Chief Louis Dekmar, was particularly affected by these inefficiencies, which limited their ability to deploy resources effectively and improve traffic safety.

Global financial institutions are heavily targeted by fraudsters and Beyond Bank is no exception. Fraudsters have access to an unprecedented amount of information and are constantly looking for ways to monetize stolen credentials. The core of Beyond Bank’s digital initiative is to deliver a customer-first strategy, and what it found was that the customers that were more vulnerable to digital fraud were least ‘technologically aware’. These vulnerable customers are often being duped via phishing attacks and mobile phone porting, leading to financial loss both for the customers and the bank. Any solution had to protect all customers, as an opt-in approach would not reach those most vulnerable. At the same time, the bank wanted to align with NPP—the industry-wide initiative for faster payments—by implementing additional levels of control and having the ability to make instant trust decisions on events. This relied on access to near real-time, dynamic intelligence; Beyond Bank needed a more holistic approach to differentiate legitimate customers from fraudsters. It was important that this approach was discreet for all customers, regardless of their level of technical skills.

As the largest non-bank card issuer, NewDay faced significant challenges from fraudsters exploiting stolen identity credentials to open credit cards online. At one point, up to 70% of NewDay applications were fraudulent, making it overwhelmingly difficult to identify good customers with established credit history from fraudsters attempting to impersonate them. Relying solely on static identity verification methods such as external bureau data proved to be ineffective, as millions of credentials have been compromised in data breaches and sold on the dark web. NewDay needed a more holistic approach to differentiate legitimate customers from fraudsters, enabling them to verify a user’s true identity in near real time.

The global entertainment company faced significant challenges in protecting its ticketing vertical from fraudsters who exploited stolen identity credentials to make online ticket purchases. The company’s existing internal fraud detection solution was insufficient to handle the sophisticated and evolving nature of cyberattacks, leading to substantial financial losses. As the company expanded its digital verticals, the risk of fraud increased, necessitating a more robust and scalable solution. The primary requirements were to reduce fraud losses, detect the use of stolen identity credentials in near real time, and prevent the monetization of digital goods without creating friction for legitimate customers.

As consumers continue to demand immediate communication and connectivity, telecommunication providers are becoming increasingly burdened by fraudsters looking to capitalize on the increased distribution of mobile phones. In launching the new mobile service, the telco recognized that it was susceptible to fraudsters looking to make money from premium handsets or defaulting on large phone bills. The company needed a solution that could accurately distinguish between legitimate and fraudulent customers in near real-time, while also promoting a frictionless experience for good, returning customers. The telco needed to be able to detect and block fraudsters signing up for new accounts using stolen identities, as well as block cybercriminals trying to take over good user accounts to order new handsets or SIMs. The company also needed a solution which would help detect fraudulent payments and identify fraudsters attempting to monetize stolen credit card credentials. As consumer behavior becomes more complex, with fraudsters becoming increasingly adept at mirroring that behavior, it was vital for the company to genuinely understand the digital identity of its connecting users and distinguish the good from the bad.

Many businesses and consumers track their income and expenses using money management applications to help give them a comprehensive view of their finances by creating budgets, tracking and paying bills, and categorizing transactions all in one place. Customers link money management applications to their bank and credit card accounts by passing their user information through the applications. Transaction data is then transferred from the banks over the Internet via a financial exchange to the applications. Many banks use Open Financial Exchange (OFX), which is an open standard API, to provide data to financial applications such as those used for banking, stock portfolios, budgeting, and money management.\n\nWhen servers began crashing at this global bank, it became apparent that its financial exchange was vulnerable to fraudsters who were performing high-velocity credentials testing. Once stolen credentials are verified, fraudsters often use them to perform additional crimes or sell them on the dark web. This global bank needed a fraud solution that could provide insight into activities occurring on its financial exchange and block fraudulent traffic without causing friction for legitimate customers.

Simplicity and innovation lie at the heart of CBD’s core values. Championing these values in a climate of rising fraud, a diverse user base and a huge proliferation in online interactions has created a number of key challenges. CBD wanted to offer a market-leading mobile banking app that provided users with banking freedom; creating easy, fun and personalized interactions without unnecessary intervention. The threat landscape in the Gulf region is evolving; fraud is continuing to see increasing growth, while the region continues to attract an incredibly diverse population of highly-mobile, sometimes disparate workers. This has created a complexity in user behavior that incorporates, for example, high-frequency travelers and customers making high value payments.

The retailer wanted to better understand the behavior of genuine good users to avoid increasing false positive rates for customers operating on the outliers of what is considered normal behavior. For example, a B2B contractor may have multiple users accessing one account from different locations and devices – a pattern of behavior which could be indicative of fraud for a consumer account. The retailer required a solution which would be able to recognize legitimate users across its varied customer base and promote a frictionless online experience for trusted customers. Streamlining the user experience was a key priority for the retailer, with plans to introduce improved e-commerce capabilities across the customer journey. For example, an expedited checkout process necessitated the need for risk-based decisioning, with the retailer requiring a solution which would protect high risk touchpoints, without compromising the user experience for trusted customers. As fraudsters continue to attempt to monetize stolen credentials, the retailer also required a solution which would accurately detect and block fraudulent transactions in near real time, without adding unnecessary friction for genuine customers.

Affordable and flexible access to premium sport content is at the core of the DAZN proposition. The live and on-demand streaming service is available as either a monthly subscription in all markets and as an annual plan in the U.S., Canada and Germany, offering fans ultimate flexibility and value. It also offers a one-month free trial in most markets, designed to attract new customers to experience the service for the first time. However, there was a risk that fraudsters could potentially sign up to consecutive free trials or generate accounts for reselling purposes. There was also the threat of bot attacks, which use stolen or spoofed identity credentials to gain access. As DAZN was rapidly scaling around the world as a new, better and fairer way to watch the best sports, it needed a partner that would help optimize registration and payment security.

Money mules have become a key enabler for a lot of 3rd party fraud and other scams which impact customers and banks across the industry. Cybercriminals, motivated by large financial gain and armed with credentials stolen from numerous data breaches, are becoming adept at taking over genuine online banking accounts. However, once the fraudster infiltrates an account using stolen credentials, or deploys social engineering tactics against a genuine customer, the money must be moved to an account which the fraudster has control over and in which the ill-gotten gains can be laundered. Defined as someone whose bank account is used to launder the proceeds of crime through the financial system, mules are engaged or recruited, either knowingly or unknowingly, for the purposes of laundering money. Hard to track, money is moved rapidly through large networks of seemingly unconnected mule accounts held at multiple financial institutions. This large financial institution was faced with the challenge of how to identify money mule activity within their online banking environment, requiring a solution which would not only detect such activity, but also help stop funds from being moved and ultimately returned to the victims of the crime.

As an incentive to sign up for an online account, this restaurant chain offered a complementary food item with every new registration to the app. It set a maximum threshold for accounts per user, but quickly found this was being abused as customers were signing up for multiple accounts from their device to take advantage of free food. Although this was hitting the company’s bottom line, a bigger problem soon emerged as a result of the mobile app accepting online payments. The company started seeing a high volume of account takeover attempts and chargebacks, which appeared to indicate an infiltration of organized cybercriminals who were attempting to log in to customer accounts with stolen/spoofed identity credentials, and test stolen credit card data. This restaurant chain needed a robust fraud solution that could accurately detect anomalous or high-risk behavior at login, as well as provide better visibility into a user’s true digital identity to understand whether they were abusing free incentive offers.

When a customer contacts a service line with a problem, they want it solved as quickly and painlessly as possible. If it takes more than one call to achieve that resolution, the frustration that customer is already likely feeling can escalate quickly and dramatically. Call center managers are highly motivated to meet customers’ desire for a one-and-done call experience. For them, the pain of a callback is particularly acute. Callbacks are a significant driver of customer churn, increased costs and ultimately, lost revenue—which is why First Call Resolution (FCR) is a metric that businesses monitor, measure and strive to improve. A top U.S. healthcare provider had FCR in their sights when they set out to reduce causes of member effort in their service center interactions. But the size and scope of their service operation made providing consistently efficient call resolution as challenging as it was imperative. They needed a streamlined and scalable way to give their members a faster, easier, better experience. To find it, they turned to Mattersight.

As one of the largest healthcare providers in the United States, this client processes millions of claims each year, which means they impact their members’ lives at a particularly sensitive point: the intersection of health and finances. People trying to understand and negotiate a medical claim are frequently overwhelmed, confused and even frightened by the paperwork and dollar amounts they’re dealing with. So this client is committed to providing those members with an experience that is as efficient and positive as possible. The pressure on agents to process claims quickly and accurately was high, and managers could see that somewhere along the line, something was breaking down. Individual processing time was slowing down, and fewer claims were being processed overall. But without any way to identify the specific causes of the problems, they were powerless to fix them. This client needed a clear understanding of their claims processing problems, and a concrete set of tools to quickly solve them. So, they enlisted Mattersight.

This client’s products and services play a central role in nearly every aspect of their customers’ lives. People don’t merely use them for entertainment; they depend on them to carry out their most vital daily activities: working, traveling, communicating, and more. When technical issues arise, a user’s life can effectively grind to a halt until a resolution is achieved. So the availability of excellent, efficient support is virtually inseparable from the products themselves— and absolutely essential to a positive customer experience. When the support center was targeted for cost cutting, a challenge arose. With an average call length of more than 20 minutes, it was clear that an opportunity existed to scale back costs by increasing call efficiency. However, compromising call quality and customer satisfaction in pursuit of that opportunity was not an option. This client was faced with two potentially conflicting goals: to reduce its operational costs in the contact center, and to maintain its exemplary level of service and support. To achieve them both, they turned to Mattersight.

As part of an effort to elevate the customer experience for their millions of users, this client partnered with Mattersight and deployed a Behavioral Analytics pilot to a subset of agents in one of their business units, with the goal of reducing repeat calls, developing predictive models for some of their key metrics and improving agent performance. In the early stages of the linguistic modeling process, Mattersight’s dual-track audio recordings revealed some unusual patterns on the agent end of this client’s unproductive outbound calls. The Behavioral Science team that discovered these anomalies shared their findings with our Customer Success team, who proceeded to dig deeper. They quickly identified four specific inappropriate behaviors— unproductive outbound calls, calls with no agent activity, abandoned calls and calls being put on hold prematurely—in a small set of recordings, then built a set of algorithms to systematically uncover them in the client’s larger body of call data. When they did, they made a startling discovery: significant inappropriate agent behavior, traced to specific outsourcer sites, which was contributing to high repeat rates, unnecessary expenditures and, undoubtedly, significant customer dissatisfaction. Not only was the client stunned when they were presented with these findings; they were infuriated. Outsourcers are paid per second of call time, which means all of that non-interaction time amounted to money down the drain — a lot of it. The outsourcers themselves, when they were informed of what was going on in their centers, were equally surprised and angered. A few bad apples, behaving in ways these vendors had no knowledge of and no way of identifying, had violated the vendors’ own standards of service, and seriously jeopardized their relationships with a highly valued customer. No one was happy, and everyone wanted the issue fixed as soon as possible.

As is the case for many financial institutions, collections represent an important part of this top retail bank’s business. Lenders need customers to repay their outstanding debts, and contacting them via telephone, repeatedly if necessary, is standard procedure. There are, however, restrictions surrounding the debt collection process. If a customer verbally notifies a bank of financial hardship, the bank must immediately cease its collection efforts, including phone calls. These restrictions are enforced by three principal regulatory bodies and pieces of legislation – the Telecommunications Consumer Protection Act (TCPA), the Consumer Financial Protection Board (CFPB), and the Office of the Comptroller of the Currency (OCC) – which require banks to sort through their customer calls and address non-compliant behavior. Manually reviewing calls for financial hardship references, and tracking these customers before they are dialed again – which often happens as soon as the next day – takes significant resources and effort and frequently results in error, the consequences of which can be severe. Customers have the right to bring legal action against a bank if the collection calls don’t stop after they give notification of hardship. With no easy way of either affirming or refuting a claim, it’s often easier for a bank to settle rather than fight. In the previous year alone, banking institutions paid out tens of millions of dollars in non-compliance settlements. Furthermore, complaints lodged against banks by consumers have been made public on the OCC website, increasing the transparency of a company’s misjudgment and negatively impacting its reputation as well as increasing regulatory scrutiny. Like most financial services companies today, our client was struggling to successfully navigate its industry’s challenging regulatory and competitive climate. It looked to its existing call recording and coaching service partner, Mattersight, for a way forward.

As the point of contact for mail-order prescription issues, this client’s call center fills a critical organizational role. With a 40% attrition rate, and the exorbitant hiring and training costs associated with that metric, it was also the source of significant budget drain. As such, it had been identified as an area ripe for cost-cutting… with a catch. The cuts absolutely could not come at the expense of service quality. Customers contact this center regarding the most important and sensitive aspect of their lives: their health. Often, they’re experiencing some degree of anxiety. In some cases, they’re quite literally calling about a matter of life or death. So it was imperative to the client that calls be handled not only quickly and efficiently, but with a high degree of interpersonal skill and effectiveness. These customers don’t just need to be taken care of; they need to feel taken care of. Like most organizations in recent years, this client was being pushed to do more with less. They turned to Mattersight to help them meet the challenge.