Custom Insurance Fraud Detection Software

Insurance fraud has existed since the start of insurance companies. These are a wide range of crimes that go undiscovered and cost the insurance business billions of dollars each year. Last year, the total loss from fraudulent insurance claims in the United States was $34 billion. Different types of insurance are vulnerable to different sorts of crimes, but in the majority of cases, it exhibits willful damage to the insured item or the intent to gain products without paying for them. Because not every claim can be thoroughly scrutinized, detecting insurance fraud can be challenging.

Insurance Fraud Detection Pipeline

The below figure is an example of an Insurance Fraud Detection pipeline in action.

ezgif.com gif maker 3 1
Figure 1: Insurance Fraud Detection Pipeline

Pipeline Stages

Stage 1: Application/Claim Request initiation.

Stage 2: Validation: Provided information is validated against social media rules and other company logic. and regulations for the authentication

Stage 3: Transmission of the application/activity data to the data sources, to be used in the AI-base System that generates the detection/prediction.

Stage 4: AI-based System will use a pre-trained ML model based on Business logic, historical data, and Text & Social Media analytics and generate the detection/prediction results relevant to the Insurance Claim stage or the Application Request (initial registration of the policy) stage.

The insurance fraud detection software is entirely automated for the client, the only human component included in the process will be the Surveyor/Analyst to connect the business processes during reporting.