Claims Fraud Detection
P&C insurers struggle with fraud, leading to losses and higher premiums. Manual reviews are slow, rule-based systems miss new fraud tactics, and black-box AI flags too many false positives, increasing workload.
CHALLENGES
Problems Our Solution Solves
- Financial Losses
Undetected fraud leads to higher claim payouts and reduced profit margins
- Inefficiencies
Excessive false positives burden investigative teams and slow down claims processing.
- Reputational Risk
Persistent fraud issues can undermine trust among policyholders and stakeholders.
OUR SOLUTIONS
Transforming
Challenges into Solutions
Claims Fraud AI can help insurance companies detect and prevent fraudulent claims more effectively, reduce financial losses, and enhance the accuracy of claims processing.
AI-Powered Fraud Detection
Deploy machine learning models to detect anomalous claim patterns using structured (policyholder data, claim history) and unstructured (medical reports, adjuster notes) data.
Outlier Detection & Behavioural Analysis
Anomaly detection algorithms flag suspicious claims based on historical data and behavioural deviations.
AI-Driven Claims Triage
Prioritize high-risk claims for further investigation while fast-tracking legitimate claims.
Human-in-the-loop
Capture and update false positive referrals to update model for future predictions.
RAG-Based Knowledge Retrieval
Provide SIU teams with AI-powered insights by retrieving past fraud cases, regulatory guidelines, and claim history for informed decision-making.
Real-Time Alerts and Risk Scoring
Automate fraud risk scoring for each claim and generate real-time alerts for suspicious cases.
IMPACTS
Why It Matters
Improved Loss Control
Enhanced detection of fraudulent claims reduces unnecessary payouts, improving the insurer’s bottom line.
Operational Efficiency
Automated triaging and alert systems enable faster investigations and resolution, freeing up resources for high-priority cases.
Regulatory Confidence
Transparent and robust audit trails help meet compliance requirements and build trust with regulators and reinsurers.
Customer Trust
Efficient fraud management can lead to lower premiums and improved service, enhancing overall customer satisfaction.
FAQs
Frequently Asked Questions
What is OverseeAI?
Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.
What type of Users can benefit from OverseeAI?
Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.
What ROI can I expect from implementing OverseeAI?
Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.
How secure is OverseeAI?
Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.
How do OverseeAI integrate with existing business tools?
Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.Manual document submission and processing in P&C insurance underwriting are slow, error-prone, and lack real-time tracking. Currently available solutions lack visibility, adaptability and interpretability.
