InsuranceComplianceRisk Management

Intelligent Fraud Detection System

Protect claims reserves with AI-powered fraud detection that identifies suspicious patterns in real-time. Automate investigation workflows and compile evidence for adjuster review.

AI operates via

Voice AgentDocument CollectionEmail AutomationCRM Sync

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How It Works

01
Claim Submission
New claim data is captured and analysed against historical patterns.
02
Risk Scoring
AI assigns fraud risk score based on multiple indicators and data points.
03
Investigation Trigger
High-risk claims automatically escalate with document and evidence requests.
04
Adjuster Review
Compiled investigation package provided to human adjuster for determination.

See How It Works

The AI Employee executes each step autonomously - no human intervention required unless explicitly configured.

Claim Submission

Risk Scoring

Investigation Trigger

Adjuster Review

Step 01

Claim Submission

New claim data is captured and analysed against historical patterns.

Step 02

Risk Scoring

AI assigns fraud risk score based on multiple indicators and data points.

Step 03

Investigation Trigger

High-risk claims automatically escalate with document and evidence requests.

Step 04

Adjuster Review

Compiled investigation package provided to human adjuster for determination.

Key Results

87%

Fraud detection rate

56%

Investigation time saved

340%

ROI on prevented losses

Frequently Asked Questions

What false positive rate does the system have?

Typically 5-8%; thresholds are customisable per client risk tolerance.

Does it learn from past fraud cases?

Yes, the system continuously refines patterns from confirmed fraud cases.

Can it detect organised fraud rings?

Yes, it identifies patterns across multiple claims and claimants.

How long does investigation take?

Automated workflows usually complete within 24-48 hours.

Is this compliant with data protection regulations?

Yes, it's built with GDPR and local data protection requirements in mind.

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