Claims Fraud Detection

Leverage AI to determine quickly and efficiently whether a Claim is likely to be Fraudulent. Machine Learning can analyze different data inputs like images of the incident, location, time, invoices, social media, publicly available data, and more – and assign a risk score to each claim. Process much more claims in less time, reduce false alerts, and increase customer satisfaction

ROI Examples

Data Needed

Incident details (example for auto: vehicle details, repair details, location and time of incident..)
Customer data (e.g. policy details, demographics)
Historical claims that have been flagged as suspicious
External Data: social media data, public data

Understand the Use-case under 5 minutes

Article

Claims fraud detection that stays ahead of fast-evolving schemes

Accelerate fraud detection and triage claims with confidence. Discover how ClaimDirectorSM leverages machine learning, extensive data sets, and predictive models to score claims for potential fraud

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Article (7 minutes)

Detecting Insurance Fraud with Machine Learning

Simple introduction for insurance frauds including the difference between traditional and machine learning approaches to detect fraudulent claims. Also, there is some intuition about startups and the technology behind fraud detection.

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Get to know more Business and Technical details about the use-case (15-30 minutes)

Deeper Intro

More detailed introduction covering business and technical aspects

Paper

AI and Insurance Fraud: decoding the mysteries of AI for the fraud-fighting community

This report seeks to help explain the differences in the various technologies and AI techniques used to detect insurance fraud. The study includes the findings from an online survey of 30 insurers representing a significant share of the property/casualty insurance market

Article (7 minutes)

Role of AI and ML in Insurance Fraud Detection

Describes the different types of insurance fraudulent claims and how machine learning algorithms can help insurers to detect false claims

Video (8 minutes)

Demo | How Shift identifies a fraudulent insurance claim with AI in automated claims processing

Live demo for intelligent detection of fraudulent claims provided by Shift-technology, the video demonstrates the company strategy of spot

Business Focused

Case studies, Organizational Aspects, Return on Investment examples

Case Study (5 minutes)

Anadolu sigorta success story

Learn how Turkish insurer Anadolu Sigorta saved 5 million Euro and realized 210% ROI after only 12 months, besides that the fixed-price project was finished within 6 months and stayed within budget

Case Study (3 minutes)

Pan-Asian insurance company improves fraud detection

Explore how a carrier increased straight through claims processing by detecting fraud, waste, and abuse in real-time. 80 % of the fraud scenarios identified as suspicious, that would have gone undiscovered

Report

NetReveal Insurance fraud solution for small and midsized insurers

NetReveal’s AI-based Claim Fraud Detection Solution and some ROI examples expected when using it

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Tech focused

More details on the technical aspects of the use-case

Article (15 minutes)

Auto Insurance Fraud Detection using K-NN Machine Learning

Applying KNN algorithm to a dataset of car insurance claims to detect ones that are likely fraudulent

Video (12 minutes)

Fraud prediction in an auto Insurance Claims Triage System.

This video introduces how to use IBM Watson Studio in a fraud prediction scenario

Article (12 minutes)

Detecting Fraudulent Claims – A Machine Learning Approach

Implementation of a Health Claims Fraud Detection model

Technical resources that will help you implement the use-case (notebooks, tutorials..)

AI Service

Databricks Notebook: Insurance Claims - Fraud Detection

End to end pipeline for claims fraud detection solution using Databricks. Steps include: data preparations, feature engineering, model development, and model tuning. Data could be found here. Another implementation here using H2O.ai

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Article + Data

For Real? Auto Insurance Fraud Claim Detection with Machine Learning

Using five different classifiers including logistic regression, k-nearest neighbors, random forest, XGBoost, and AdaBoost to detect auto insurance fraud. to detect insurance fraudulent claims.

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Paper (26 minutes)

Comparative Analysis of Machine Learning Techniques for Detecting Insurance Claims Fraud

Multiple machine learning techniques for fraud detection are presented and their performance on various datasets examined. The impact of feature engineering, feature selection, and parameter tweaking are explored to achieve superior predictive performance

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Video (26 minutes)

How to use special machine learning techniques to detect insurance claims fraud

Learn how to pre-process data properly, tune hyperparameters and train your model to detect and prevent insurance fraud.

Kaggle Notebook

Fraud Detection in Insurance Claims

Step by step implementation for an auto insurance fraud detection model. Includes: data exploration & cleaning, visualization, feature extraction, and training different models

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Data Sets you can use to build Demos, POCs, or test Algorithms

Fraud Detection in Insurance Claims

Claims for a car insurance company in the United States. The data consists of 1000 individual claims of insurance policies details including policy number, policy blind date, policy state, etc.

Off-the-Shelf Products using AI for Claims Fraud Detection

Got a Question or a Resource to share with the Community? Please do!

Claims Fraud Detection

1. Get Inspired

Claims fraud detection that stays ahead of fast-evolving schemes

Detecting Insurance Fraud with Machine Learning

2. Know More

Deeper Intro

AI and Insurance Fraud: decoding the mysteries of AI for the fraud-fighting community

Role of AI and ML in Insurance Fraud Detection

Demo | How Shift identifies a fraudulent insurance claim with AI in automated claims processing

Business Focused

Anadolu sigorta success story

Pan-Asian insurance company improves fraud detection

NetReveal Insurance fraud solution for small and midsized insurers

Tech focused

Auto Insurance Fraud Detection using K-NN Machine Learning

Fraud prediction in an auto Insurance Claims Triage System.

Detecting Fraudulent Claims – A Machine Learning Approach

3. Do

Databricks Notebook: Insurance Claims - Fraud Detection

For Real? Auto Insurance Fraud Claim Detection with Machine Learning

Comparative Analysis of Machine Learning Techniques for Detecting Insurance Claims Fraud

How to use special machine learning techniques to detect insurance claims fraud

Fraud Detection in Insurance Claims

Data Sets

Fraud Detection in Insurance Claims

Solutions