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Insurance Fraud Detection

The insurance industry has been plagued by fraud for several decades now. According to estimates, fraud accounts for up to 10% of all claim expenditure in Europe, leading to substantial losses for both insurers and their customers, as the unwarranted costs translate into higher premiums. In this project, we delivered a custom AI-driven solution assessing the risk that a claim qualifies as potentially fraudulent.

Industry: InsurTech

Project Category: AI, data analytics, software development

Lead Member: QuantUp

Project Description & Client Benefits

Our client - one of the main insurers in Poland - experienced the negative effects of fraudulent claims and was looking for ways to increase the level of fraud detection in the field of transport insurance packages. When they approached us, we discovered that some flaws in the customer's existing system led to additional, unreasonable costs and also significantly extended the time it takes to process claims related documents.

By analyzing our client's systems, we proposed a new approach to the claims handling process and related claims handling documents. Our team provided a custom AI/ML solution supporting the assessment process of whether a claim should qualify as potentially fraudulent.

The implementation of the proprietary solution immediately improved the effectiveness of fraud detection. The company can now better identify which cases need to be investigated further, and the percentage of claims identified as fraudulent has also increased. As a result, our client significantly reduced the costs related to the handling and payment of fraudulent claims.

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