An insurer loses money two ways. Out the front, as fraudulent claims. Out the back, as a breached member record. Nemesis closes both leaks from one agent, on a shared view of every member and provider.
The two leaks
- Claims out the door. Across the market, roughly a quarter of claims are fraudulent, wasteful or abusive: phantom and ghost-patient billing, ghost enrollees, upcoding, duplicate and inflated claims, and provider-member collusion. Insurance fraud costs hundreds of billions a year globally.
- Data out the back. Health and insurance records are the most valuable data on the dark web and the costliest to breach, year after year. Ransomware has exposed hundreds of millions of members, and member portals are drained by account takeover and API abuse.
The connection you can exploit: the same fraud ring that takes over a member's portal login also files the fraudulent claim behind it. When the fraud engine and the security layer are the same system, you catch both.
What Nemesis does
One agent, three capabilities on one entity graph:
- Omniguard scores every claim for phantom billing, ghost enrollees, upcoding, duplicates and provider collusion, and covers sanctions screening and STR filing for your life book.
- Application Shield protects your member and provider portals, mobile apps and claims APIs from account takeover, API abuse and zero-days, so the breach never happens.
- Blue defends the servers and staff endpoints that hold member records against ransomware and insider theft.
It works alongside your existing claims platform, not against it.
The number your Head of Claims already knows
Claims fraud is the textbook machine-learning problem: high volume, repeating patterns, a clear right answer. If a fifth of premiums leak to fraud, waste and abuse, then even a modest recovery is a direct, measurable addition to the bottom line, the easiest business case in the building to prove.
Getting started
Start with a 30-day pilot over a sample of your own claims, observe-only. We show you how much fraud is in them, and what is hitting your portals, before you commit.