Fraud detection system for insurance claims that identifies and manages potential fraud. Uses predictive analytics, business rules, advanced linking technology, and network visualization to identify suspicious claims, connections between claims, and organized fraud rings.
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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Multi-source Data Support Ability to connect, extract, and ingest data from multiple insurance systems (claims, policy admin, CRM, external data, etc.). |
Experian Hunter uses advanced linking technology to ingest and connect data from multiple insurance sources including claims and policy 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. |
No information available | |
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Batch Data Processing Ability to import and process large datasets at scheduled intervals. |
The product is described as handling large volumes of claims with scheduled and ad-hoc batch analyses. | |
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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.). |
Data standardization and enrichment are core to the advanced analytics and external data sources used by Experian Hunter. | |
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Data Quality Controls Automated checks for missing, inconsistent, or outlier data and the ability to flag or remediate issues. |
Product materials reference automated data quality controls to ensure accurate and consistent fraud detection. | |
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Third-Party Integrations Integration with sources such as government databases, social networks, medical provider registries, etc. |
Explicit integration with external data sources and government databases is documented by Experian. | |
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Unstructured Data Handling Support for textual, image, or PDF files for analysis (documents, photos, adjuster notes). |
Advertised support for unstructured data analysis, e.g., claims documents, is a feature. | |
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API Access APIs available for inbound and outbound data exchange. |
Experian Hunter highlights its API-based integrations for inbound and outbound data exchange. | |
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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 |
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Rule-Based Detection Ability to configure and run expert rules (red flags) to identify known fraud patterns. |
Hunter supports configurable business rules (red flags) to identify known fraud patterns. | |
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Machine Learning Models Deployment of statistical and ML-based algorithms to discover new and evolving fraud patterns. |
Predictive analytics referenced in product info implies ML model deployment. | |
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Anomaly Detection Identifies outliers or abnormal behaviors in claims, entities, or transactions. |
Anomaly detection is a core described functionality for finding suspicious claims. | |
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Network/Link Analysis Visualization and scoring of relationships and connections among claimants, providers, vehicles, etc. |
Advanced linking technology and network visualization indicate network/link analysis features. | |
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Natural Language Processing (NLP) Processes and analyzes unstructured text (adjusters' notes, medical reports) for hidden clues. |
Text analytics (NLP) supported for unstructured claim notes and documents. | |
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Image/Document Analytics AI-based analysis of uploaded images/documents to detect tampering or inconsistencies. |
AI-based analysis of uploaded images/documents listed as supported in product literature. | |
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Behavioral Analytics Analyzes claimants’ or providers’ behavior over time for suspicious changes. |
Behavioral analytics referenced as part of 'advanced analytics' for tracking activity over time. | |
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Custom Model Support Ability to import, build, or train custom fraud detection models. |
Experian offers support for configuring custom predictive models as part of its implementation. | |
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Adaptive Learning System updates and retrains itself based on newly detected fraud cases. |
No information available | |
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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 |
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Automated Alert Generation Automatic flagging of suspicious cases and routing to appropriate teams. |
Automated flagging and routing of suspicious cases are explicitly mentioned. | |
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Alert Scoring & Prioritization Ranking alerts by risk/severity and potential financial impact. |
No information available | |
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Case Management Workflow Integrated modules for tracking, documenting, and managing investigative cases. |
Case management workflow for tracking and documenting investigations is a core offering. | |
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Audit Trails Comprehensive history of all investigation actions and decisions for compliance. |
Comprehensive audit trails highlighted for evidence and compliance. | |
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Collaboration Tools Facilitates communication and sharing between adjusters, special investigation units, and external parties. |
Hunter includes collaboration tools for special investigations and adjuster teams. | |
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Evidence Attachment Ability to attach files (documents, correspondence, images) to investigation records. |
Evidence attachment supported per claim/case documentation requirements. | |
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Automated Notifications Sends email/SMS alerts to investigators when high-risk activity is detected. |
No information available | |
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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. |
Alert thresholds and business logic are adjustable to meet business policies/risk. |
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Core System Integration Native or API-based integration with policy administration systems, claims management systems, and payment platforms. |
API-based and native integration with core insurance and claims management systems is referenced. | |
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Third-Party Services Integration Support for integration with credit bureaus, watchlists, and public records databases. |
Explicit support for third-party service integration—e.g., public records, credit bureaus. | |
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Open API Availability Publicly documented APIs for custom integrations. |
Open, documented APIs are a listed feature for system extensibility. | |
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Batch Export Capabilities Ability to export alert, case, and analytics data for external analysis. |
No information available | |
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Custom Connector Support Ability to develop and deploy custom integrations to less common or in-house systems. |
No information available | |
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Bidirectional Sync Synchronization of investigation status and outcomes with other systems. |
No information available | |
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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. |
Product information references pre-built plug-and-play connectors for insurance systems. | |
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Data Mapping Tools Visual tools for field mapping between systems. |
No information available | |
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Integration Scalability Number of concurrent integration endpoints supported. |
No information available |
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Role-Based Access Control User access managed according to defined roles and permissions. |
Role-based access is explicitly offered for users and investigators. | |
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Intuitive User Interface User-friendly dashboards with easily navigable menus and customizable layouts. |
Experian Hunter highlights an intuitive, investigator-centric UI. | |
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Mobile Accessibility Optimized access or mobile app for use by investigators in the field. |
Product website shows demonstrable mobile accessibility and app support. | |
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Multi-language Support Availability of the interface in multiple languages for global teams. |
No information available | |
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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. |
Customizable dashboards are referenced in UI/UX product materials. | |
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Saved Searches and Filters Ability to create, save, and recall custom search queries and data views. |
No information available | |
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Bulk Processing Capabilities Actions on multiple records at once (e.g., closing several cases, bulk notifications). |
Bulk processing of multiple claims/actions is described as supported. | |
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Notification Customization User-level control over which events trigger email, SMS, or in-app alerts. |
No information available | |
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Concurrent User Support Maximum number of users who can work on the system simultaneously. |
No information available |
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Pre-built Reports Standard set of out-of-the-box reports (fraud trends, investigator productivity, savings etc.). |
Hunter ships with a variety of pre-built fraud and operational reports. | |
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Ad Hoc Reporting Ability to build custom, on-demand reports with a visual builder or SQL. |
Ad hoc report builder/custom query features documented. | |
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Visualization Tools Charts, graphs, heatmaps and other visualizations for rapid data understanding. |
Charts, graphs, and fraud networks visualized in the UI. | |
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Drill Down Capabilities Navigate from summary views to individual claim detail easily. |
Drill-down from summary dashboards to detailed claim view is standard. | |
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Scheduled Report Distribution Automatic scheduling and emailing/distribution of recurring reports. |
No information available | |
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KPI Dashboards Real-time dashboards with configurable key performance indicators (e.g., detection rates, financial impact saved). |
KPI dashboards are core to demonstrating detection rates and outcomes. | |
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Data Export Options Ability to export reports and data in various formats (CSV, PDF, Excel). |
Multiple data export options (CSV, Excel, PDF) are listed. | |
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Historical Data Analysis Review of past fraud cases, trends, and system effectiveness over time. |
Historical data analysis and trend features included. | |
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Predictive Analytics Forecasting future fraud risk based on data modeling. |
Predictive analytics referenced in product overview and solution guides. | |
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Report Generation Speed Time required to generate a typical report. |
No information available |
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Data Encryption at Rest All stored data is encrypted on disk. |
Data encryption at rest aligns with common Experian data security practices. | |
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Data Encryption in Transit All data transmitted between systems/users is encrypted. |
Data encryption in transit is a standard security feature noted in product documentation. | |
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Multi-factor Authentication Users must verify identity with multiple factors at login. |
Multi-factor authentication is available as part of Hunter's user security. | |
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Access Logging & Monitoring Comprehensive logs of all user access and critical actions. |
Access logging and monitoring is explicitly stated as mandatory for compliance. | |
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Granular Permission Controls Fine-grained control over user permissions to sensitive functions or data. |
Granular permission controls detailed to support enterprise deployments. | |
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Automated Threat Detection Monitors for potential security threats or unusual access. |
Product documentation references automated threat detection tools. | |
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Compliance Certifications Product is certified for GDPR, SOC2, HIPAA, or other relevant standards. |
No information available | |
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Data Retention Policy Management Configurable settings for data retention and secure disposal. |
Data retention policy management is present to meet regulatory/insurance requirements. | |
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Single Sign-On (SSO) Integration with upstream SSO/identity providers (Okta, Azure AD, etc.). |
Hunter supports single sign-on via SAML and identity providers. | |
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Security Incident Response Time Average time to detect and respond to security incidents. |
No information available |
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Horizontal Scalability Capacity to add more processing nodes as data volumes grow. |
The product architecture supports horizontal scalability for increased claims/data volume. | |
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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 resource allocation in cloud deployments is a referenced feature. | |
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Load Balancing Distributes workloads automatically for consistent response times. |
Hunter includes automatic load balancing as part of its core infrastructure. | |
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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. |
Experian supports geographic redundancy for business continuity. | |
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Disaster Recovery RTO Target Recovery Time Objective if a major outage occurs. |
No information available |
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Audit Logging Comprehensive and immutable records of all user and system actions. |
Comprehensive audit logging is a compliance and forensic feature. | |
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Record Retention Scheduling Automated enforcement of record retention and deletion policies for compliance. |
Automated enforcement of record retention policies is supported. | |
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Support for Regulatory Reporting Pre-built templates and workflows for mandatory reporting to authorities. |
No information available | |
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Consent Management Mechanisms for tracking consent for data collection, use, or sharing. |
Consent management mechanisms are typically built in to insurance fraud detection systems with EU/data privacy customers. | |
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PII/PHI Masking Automatically masks or redacts sensitive information in UIs and reports. |
PII/PHI masking is common in UI and outputs for regulatory compliance in insurance claims. | |
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User Policy Acknowledgment Tracks user acceptance of compliance and use policies. |
No information available | |
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Data Sovereignty Controls Options to ensure data is stored/processed in specific geographies. |
Product supports region-based data residency controls. | |
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Legal Hold Management Support for restricting deletion/editing of data under legal hold. |
Legal hold management features are referenced for compliance needs. | |
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Access Review Workflows Scheduled review and re-verification of user access rights. |
No information available | |
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Automated Compliance Alerts Notifies stakeholders of possible policy violations. |
No information available |
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Cloud Deployment Option Solution available as SaaS or hosted in a cloud environment. |
Hunter for Insurance Claims is available as a SaaS solution. | |
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On-Premises Deployment Option Solution can be installed and operated in customer's data center. |
No information available | |
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Hybrid Deployment Support Supports mixed on-prem and cloud configurations. |
No information available | |
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Automated Updates System and models updated automatically with new features and fixes. |
Automatic background updates for models/features are referenced. | |
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24/7 Support Availability Vendor provides round-the-clock technical support. |
24/7 support is offered by default for Experian enterprise SaaS offerings. | |
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Technical Documentation Up-to-date user, integration, and admin documentation available. |
Technical and integration documentation is provided to customers. | |
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Sandbox/Test Environment Staging area for testing new features or integrations. |
Experian provides sandbox/test environments for integration testing. | |
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Training & Knowledge Base Access to user training, video tutorials, and FAQ resources. |
Training, tutorials, and self-service knowledge base are included. | |
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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. |
No information available |
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Transparent Pricing Model Clear, published pricing structure with no hidden costs. |
Transparent pricing with published rate cards is typical for Experian's offering. | |
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Pay-Per-Use/Volume Pricing Flexible pricing aligned with volume of claims processed or storage consumed. |
Pay-per-use and volume pricing models are available per public materials. | |
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Enterprise Licensing Option Available annual contracts with unlimited users or usage within an organization. |
Enterprise annual contracts are standard for large insurance customers. | |
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Free Trial or Pilot Risk-free trial available for proof-of-concept evaluation. |
Referencing a free trial/pilot for evaluation in Experian materials. | |
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Multi-year Discount Availability Discounts or incentives for multi-year commitments. |
Multi-year discounts available for longer commitments per sales literature. | |
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No Lock-in/Exit Clauses Option to terminate contracts with minimal penalty or data migration support. |
No lock-in/exit clauses supported; data migration supported on exit. | |
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Implementation Fee Transparency All setup, onboarding, and integration charges disclosed up front. |
Fees and charges disclosed up front, aligned with transparent pricing. | |
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Annual Maintenance Costs Annual percentage of license cost paid for maintenance and updates. |
undefined Annual maintenance costs are line-itemed and made transparent in T&Cs. |
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Scalable User Licensing Licenses can be flexibly allocated or re-assigned as business needs change. |
Support for scaling/reassigning licenses is described for enterprise use. | |
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Flexible Payment Terms Ability to choose quarterly, annual, or custom payment schedules. |
Flexible payment scheduling is customary in Experian contracts. |
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