Claims Automation
Automate claims intake, triage and straight-through settlement of simple claims while routing complex ones to adjusters.
Insurance Fraud Detection
Identify suspicious claims without delaying genuine ones
Detect suspicious claims, application misrepresentation and organised fraud networks with explainable analytics.
The problem
Why this matters
Insurance fraud ranges from exaggerated claims to organised rings involving staged incidents and complicit providers. Investigating every claim is impossible, and blunt controls delay legitimate settlements and damage customer trust.
Common challenges
- Organised fraud spanning multiple claims, policies and providers
- Manipulated documents, invoices and images
- High referral volumes overwhelming special investigation units
- Need for explainable referrals that investigators trust
Our approach
How we work
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Profile fraud patterns
Analyse historical cases and typologies with investigators.
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Score claims
Combine rules and models to prioritise referrals with reasons.
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Link entities
Expose networks of claimants, providers, vehicles and addresses.
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Close the loop
Feed investigation outcomes back into detection.
Capabilities
What our insurance fraud detection work covers
- 01
Claims fraud scoring
Explainable risk scores at first notice of loss and through the claim.
- 02
Document & image forensics
Tamper detection on invoices, reports and photographs.
- 03
Network analytics
Graph analysis of claimants, providers and assets.
- 04
Application fraud
Detection of misrepresentation and non-disclosure at proposal stage.
- 05
Health claims analytics
Provider billing anomaly detection for health insurers and TPAs.
- 06
SIU case management
Investigation workflows with evidence and outcome tracking.
Engagement
Deliverables and benefits
What you receive
- Fraud typology and data assessment
- Detection rules and model design
- Network analytics capability
- SIU workflow and feedback design
What it changes
- Better-targeted investigations
- Faster settlement for genuine claims
- Visibility of organised fraud
Standards & technology
FAQ
Frequently asked questions
Can this work for health insurance and TPAs?
Yes. Health claims fraud and provider billing anomalies are common use cases, with features tailored to clinical and billing data.
Discuss your insurance fraud detection requirements
Let’s discuss it. Tell us what you are working on and an engineer — not a sales script — will respond.