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SAS Detection and Investigation for Insurance from SAS
Comprehensive fraud detection solution that combines advanced analytics, machine learning, AI, and network analysis to identify suspicious claims. Offers alert generation, case management, reporting, visualization tools, and model governance to detect both known and unknown fraud patterns.
Product analysis by function
Fraud Detection Solutions for Claims Management
AI-powered tools that identify suspicious patterns, anomalies, and potential fraudulent activities in claims data. These solutions use advanced algorithms to flag high-risk claims for further investigation.
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Data Integration & Ingestion
(8 Yes /8 Known /10 Possible features)
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Multi-source Data Support Ability to connect, extract, and ingest data from multiple insurance systems (claims, policy admin, CRM, external data, etc.). |
SAS Detection and Investigation for Insurance documentation outlines support for ingesting data from policy, claims, CRM, and external systems. | |
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Real-Time Data Ingestion Capability to onboard and process data as it is created or updated, enabling timely fraud detection. |
Product highlights real-time ingestion for timely fraud detection as part of its analytics and alerting capabilities. | |
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Batch Data Processing Ability to import and process large datasets at scheduled intervals. |
Batch data import, scheduled analytics and ETL listed on the product’s technical briefs. | |
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Data Standardization & Enrichment Automatic transformation of diverse data formats into standardized formats, and enrichment with external sources (public records, watchlists, etc.). |
SAS provides data standardization, cleansing, and enrichment, including use of external datasets. | |
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Data Quality Controls Automated checks for missing, inconsistent, or outlier data and the ability to flag or remediate issues. |
Automated data quality checks and controls are part of the SAS Data Management solution, which underpins this product. | |
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Third-Party Integrations Integration with sources such as government databases, social networks, medical provider registries, etc. |
Integrates with government, credit, and social data sources; detailed on product site. | |
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Unstructured Data Handling Support for textual, image, or PDF files for analysis (documents, photos, adjuster notes). |
Described as able to analyze free text, images, and documents; unstructured data supported. | |
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API Access APIs available for inbound and outbound data exchange. |
APIs available for both inbound and outbound integrations (SAS Open APIs documented). | |
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Data Storage Capacity Maximum supported data storage for large and growing datasets. |
No information available | |
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Data Latency Average time lag between data ingestion and availability for analysis. |
No information available |
Detection Techniques & Algorithms
(9 Yes /9 Known /11 Possible features)
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Rule-Based Detection Ability to configure and run expert rules (red flags) to identify known fraud patterns. |
Expert rule creation and business rule configuration explicitly included in product capabilities. | |
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Machine Learning Models Deployment of statistical and ML-based algorithms to discover new and evolving fraud patterns. |
ML/AI models are core to the product’s detection of new and evolving fraud patterns. | |
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Anomaly Detection Identifies outliers or abnormal behaviors in claims, entities, or transactions. |
Anomaly detection called out as a major analytic technique used in the platform. | |
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Network/Link Analysis Visualization and scoring of relationships and connections among claimants, providers, vehicles, etc. |
Described in product literature as 'network analytics' for visualizing and scoring connections. | |
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Natural Language Processing (NLP) Processes and analyzes unstructured text (adjusters' notes, medical reports) for hidden clues. |
NLP listed as method for analyzing notes and documents in system's feature matrix. | |
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Image/Document Analytics AI-based analysis of uploaded images/documents to detect tampering or inconsistencies. |
Image and document analytics/AI explicitly included for document tamper detection. | |
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Behavioral Analytics Analyzes claimants’ or providers’ behavior over time for suspicious changes. |
Behavioral analysis tools allow detection of deviations in claimant/provider actions. | |
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Custom Model Support Ability to import, build, or train custom fraud detection models. |
Support for custom model import, building, and training confirmed in product technical documentation. | |
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Adaptive Learning System updates and retrains itself based on newly detected fraud cases. |
Adapts models based on new outcomes and feedback (described as adaptive learning). | |
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False Positive Rate Percentage of legitimate claims incorrectly flagged as fraudulent. |
No information available | |
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Detection Accuracy Overall accuracy of the fraud detection algorithms. |
No information available |
Alerting & Investigation Support
(8 Yes /8 Known /10 Possible features)
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Automated Alert Generation Automatic flagging of suspicious cases and routing to appropriate teams. |
Alerts generated and routed automatically when suspicious patterns detected; mentioned in multiple solution descriptions. | |
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Alert Scoring & Prioritization Ranking alerts by risk/severity and potential financial impact. |
Alerts are scored and prioritized by severity and risk within the tool. | |
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Case Management Workflow Integrated modules for tracking, documenting, and managing investigative cases. |
Full case management workflow described throughout product literature. | |
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Audit Trails Comprehensive history of all investigation actions and decisions for compliance. |
Audit trails are maintained and reported for all key investigation steps. | |
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Collaboration Tools Facilitates communication and sharing between adjusters, special investigation units, and external parties. |
Features for investigator collaboration including notes, internal chat, and sharing of evidence are in product documentation. | |
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Evidence Attachment Ability to attach files (documents, correspondence, images) to investigation records. |
Evidence, including documents and images, can be attached directly to cases. | |
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Automated Notifications Sends email/SMS alerts to investigators when high-risk activity is detected. |
Alerts via email and notification for high-risk cases are configurable in the product. | |
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Investigation Cycle Time Average time to resolve a flagged claim from initial alert to closure. |
No information available | |
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Case Volume Supported Maximum number of concurrent investigations supported by the system. |
No information available | |
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Customizable Alert Thresholds Adjust criteria for triggering alerts to suit business policies or risk appetite. |
Alerting logic and thresholds are configurable per business policies. |
Integration & Interoperability
(8 Yes /8 Known /10 Possible features)
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Core System Integration Native or API-based integration with policy administration systems, claims management systems, and payment platforms. |
Integration with core insurance and payment systems is a highlighted SAS benefit. | |
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Third-Party Services Integration Support for integration with credit bureaus, watchlists, and public records databases. |
Integration support for third-party data providers (watchlists, credit, public records) included. | |
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Open API Availability Publicly documented APIs for custom integrations. |
Open, documented APIs are a standard feature of SAS enterprise offerings. | |
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Batch Export Capabilities Ability to export alert, case, and analytics data for external analysis. |
Batch export of analytics and case data for external analysis is supported. | |
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Custom Connector Support Ability to develop and deploy custom integrations to less common or in-house systems. |
Custom connectors can be developed and deployed for customer-specific systems. | |
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Bidirectional Sync Synchronization of investigation status and outcomes with other systems. |
Bidirectional sync of statuses and results supported through integration API. | |
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Integration Response Time Average latency for data exchange between the solution and integrated platforms. |
No information available | |
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Plug-and-Play Connectors Pre-built connectors to major core insurance systems and commercial data providers. |
Pre-built connectors to major systems (Guidewire, Duck Creek, etc.) are available. | |
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Data Mapping Tools Visual tools for field mapping between systems. |
Visual data mapping tools available for integration builds. | |
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Integration Scalability Number of concurrent integration endpoints supported. |
No information available |
User Experience & Accessibility
(8 Yes /8 Known /10 Possible features)
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Role-Based Access Control User access managed according to defined roles and permissions. |
Role-based permissions are standard in SAS enterprise and analytics platforms. | |
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Intuitive User Interface User-friendly dashboards with easily navigable menus and customizable layouts. |
Product demo videos and literature emphasize customizable UI and ease-of-use. | |
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Mobile Accessibility Optimized access or mobile app for use by investigators in the field. |
Mobile accessibility and app support are indicated as a product feature for field investigators. | |
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Multi-language Support Availability of the interface in multiple languages for global teams. |
Global enterprise clients are supported, with interface translations for multiple languages. | |
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Screen Reader Compatibility Accessibility support for visually impaired users. |
No information available | |
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Customizable Dashboards Personalized widgets, views, and alert preferences per user. |
Dashboards are customizable per user or role. | |
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Saved Searches and Filters Ability to create, save, and recall custom search queries and data views. |
Saved searches and filters are supported in the investigative workflow interface. | |
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Bulk Processing Capabilities Actions on multiple records at once (e.g., closing several cases, bulk notifications). |
Bulk actions (such as closing or assigning cases) supported for investigator efficiency. | |
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Notification Customization User-level control over which events trigger email, SMS, or in-app alerts. |
Individual users can set alert and notification preferences. | |
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Concurrent User Support Maximum number of users who can work on the system simultaneously. |
No information available |
Reporting, Analytics & Insights
(9 Yes /9 Known /10 Possible features)
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Pre-built Reports Standard set of out-of-the-box reports (fraud trends, investigator productivity, savings etc.). |
Standard, out-of-the-box reporting templates for fraud and productivity are advertised. | |
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Ad Hoc Reporting Ability to build custom, on-demand reports with a visual builder or SQL. |
Ad hoc, custom report-building capabilities are standard in SAS analytics suite. | |
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Visualization Tools Charts, graphs, heatmaps and other visualizations for rapid data understanding. |
Charts, graphs, network maps and other visualizations are emphasized in marketing materials. | |
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Drill Down Capabilities Navigate from summary views to individual claim detail easily. |
Drill-down from high-level metrics to individual case detail described as a feature. | |
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Scheduled Report Distribution Automatic scheduling and emailing/distribution of recurring reports. |
Report distribution and scheduling capabilities are part of SAS reporting engine. | |
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KPI Dashboards Real-time dashboards with configurable key performance indicators (e.g., detection rates, financial impact saved). |
Configurable, real-time KPI dashboards are readily available for key metrics. | |
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Data Export Options Ability to export reports and data in various formats (CSV, PDF, Excel). |
SAS platform supports data export in CSV, Excel, PDF, and other common formats. | |
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Historical Data Analysis Review of past fraud cases, trends, and system effectiveness over time. |
Analysis of historical data (fraud trends, effectiveness) is a key analytics feature. | |
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Predictive Analytics Forecasting future fraud risk based on data modeling. |
Predictive analytics using models for future fraud risk is a core benefit, per product info. | |
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Report Generation Speed Time required to generate a typical report. |
No information available |
Security & Privacy
(9 Yes /9 Known /10 Possible features)
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Data Encryption at Rest All stored data is encrypted on disk. |
SAS encrypts all data at rest using industry standard practices. | |
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Data Encryption in Transit All data transmitted between systems/users is encrypted. |
Data in transit is secured with TLS/SSL and strong encryption. | |
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Multi-factor Authentication Users must verify identity with multiple factors at login. |
Multi-factor authentication support available for user login. | |
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Access Logging & Monitoring Comprehensive logs of all user access and critical actions. |
Access logs and user activity monitoring included as standard security practices. | |
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Granular Permission Controls Fine-grained control over user permissions to sensitive functions or data. |
Granular permission controls are configurable by admin to restrict feature/data access. | |
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Automated Threat Detection Monitors for potential security threats or unusual access. |
SAS solutions include automated threat monitoring and detection tools. | |
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Compliance Certifications Product is certified for GDPR, SOC2, HIPAA, or other relevant standards. |
SAS claims compliance with common standards (GDPR, SOC 2, HIPAA) for its cloud solutions. | |
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Data Retention Policy Management Configurable settings for data retention and secure disposal. |
Configurable retention/disposal of data, supporting enterprise data governance policies. | |
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Single Sign-On (SSO) Integration with upstream SSO/identity providers (Okta, Azure AD, etc.). |
Single Sign-On (SSO) via multiple identity providers available. | |
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Security Incident Response Time Average time to detect and respond to security incidents. |
No information available |
Scalability & Performance
(4 Yes /4 Known /10 Possible features)
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Horizontal Scalability Capacity to add more processing nodes as data volumes grow. |
Horizontal scalability, including cluster expansion for larger volumes, is advertised. | |
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Processing Throughput Maximum number of claims processed per hour. |
No information available | |
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System Uptime SLA Guaranteed minimum system uptime by the vendor. |
No information available | |
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Peak Concurrent User Support Highest number of users supported during peak loads. |
No information available | |
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Elastic Resource Allocation Automatic scaling of compute and storage resources as usage fluctuates. |
Elastic (on-demand) compute and storage scaling is a feature in the SAS Viya cloud environment. | |
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Load Balancing Distributes workloads automatically for consistent response times. |
Automated load distribution is provided to ensure consistent response. | |
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Response Time (Normal Load) Average expected user response time during typical volume. |
No information available | |
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Response Time (Peak Load) Average expected user response time during peak volume. |
No information available | |
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Geographic Redundancy Deployment in multiple geographic regions/data centers for business continuity. |
Geographic redundancy, with multiple regions and data centers, is described for SAS Cloud. | |
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Disaster Recovery RTO Target Recovery Time Objective if a major outage occurs. |
No information available |
Compliance & Regulatory Support
(10 Yes /10 Known /10 Possible features)
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Audit Logging Comprehensive and immutable records of all user and system actions. |
Audit logging provided for both compliance and investigation traceability. | |
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Record Retention Scheduling Automated enforcement of record retention and deletion policies for compliance. |
Automated record retention/deletion policies supported according to governing regulations. | |
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Support for Regulatory Reporting Pre-built templates and workflows for mandatory reporting to authorities. |
Pre-built options for regulatory reporting are mentioned for insurance compliance (e.g., SIU reporting). | |
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Consent Management Mechanisms for tracking consent for data collection, use, or sharing. |
Tracking and management of user consent for data collection are available. | |
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PII/PHI Masking Automatically masks or redacts sensitive information in UIs and reports. |
Automatic masking/redacting of sensitive PII/PHI in UIs and exports described. | |
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User Policy Acknowledgment Tracks user acceptance of compliance and use policies. |
User policy acceptance can be tracked/audited per user account. | |
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Data Sovereignty Controls Options to ensure data is stored/processed in specific geographies. |
Data sovereignty and regional restrictions available in SAS Cloud/Enterprise deployment. | |
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Legal Hold Management Support for restricting deletion/editing of data under legal hold. |
Legal hold management for compliance with regulatory/legal requirements documented. | |
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Access Review Workflows Scheduled review and re-verification of user access rights. |
Regular access reviews supported as part of security workflows. | |
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Automated Compliance Alerts Notifies stakeholders of possible policy violations. |
Automated compliance alerts supported for policy violations. |
Deployment, Maintenance & Support
(9 Yes /9 Known /10 Possible features)
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Cloud Deployment Option Solution available as SaaS or hosted in a cloud environment. |
Offered as a SaaS/Cloud solution (SAS Viya cloud) or via hosting partners. | |
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On-Premises Deployment Option Solution can be installed and operated in customer's data center. |
Can be deployed on-premises in private data centers if required. | |
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Hybrid Deployment Support Supports mixed on-prem and cloud configurations. |
Hybrid options (cloud/on-prem) are possible as documented on product’s technical offering. | |
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Automated Updates System and models updated automatically with new features and fixes. |
SAS regularly updates models and features; automated update cadence is available. | |
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24/7 Support Availability Vendor provides round-the-clock technical support. |
SAS advertises global, 24/7 support (phone/email/support portal). | |
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Technical Documentation Up-to-date user, integration, and admin documentation available. |
Comprehensive documentation is provided via the SAS support portal. | |
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Sandbox/Test Environment Staging area for testing new features or integrations. |
Sandbox/test environments are available for new feature and integration testing. | |
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Training & Knowledge Base Access to user training, video tutorials, and FAQ resources. |
Training resources (documentation, guides, videos) are part of SAS support. | |
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Upgrade Downtime Maximum expected system downtime for scheduled upgrades. |
No information available | |
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Dedicated Customer Success Manager Assigned vendor resource to support onboarding and ongoing engagement. |
Customer success/engagement managers are typically assigned to enterprise accounts. |
Cost & Commercial Flexibility
(9 Yes /9 Known /10 Possible features)
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Transparent Pricing Model Clear, published pricing structure with no hidden costs. |
Pricing is transparently disclosed to enterprise buyers; breakdowns available on request. | |
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Pay-Per-Use/Volume Pricing Flexible pricing aligned with volume of claims processed or storage consumed. |
Volume/usage-based pricing models are offered to large clients. | |
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Enterprise Licensing Option Available annual contracts with unlimited users or usage within an organization. |
Enterprise unlimited-use agreements are available. | |
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Free Trial or Pilot Risk-free trial available for proof-of-concept evaluation. |
Free trial/pilot engagement arrangements are available for proof-of-concept. | |
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Multi-year Discount Availability Discounts or incentives for multi-year commitments. |
Multi-year pricing discounts/incentives are part of typical enterprise commercial terms. | |
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No Lock-in/Exit Clauses Option to terminate contracts with minimal penalty or data migration support. |
Exit flexibility and data migration support offered in contracts. | |
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Implementation Fee Transparency All setup, onboarding, and integration charges disclosed up front. |
All setup, onboarding, and integration fees are disclosed during SAS sales process. | |
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Annual Maintenance Costs Annual percentage of license cost paid for maintenance and updates. |
No information available | |
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Scalable User Licensing Licenses can be flexibly allocated or re-assigned as business needs change. |
User licenses may be allocated or reassigned as needed (flexible licensing models supported). | |
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Flexible Payment Terms Ability to choose quarterly, annual, or custom payment schedules. |
Flexible quarterly/annual/custom payment schedules offered to enterprise/government clients. |
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