Identify fraudulent & suspicious claims through ML technique
Problem statement
Fraud detection and prevention: Insurance companies must be able to detect and prevent fraudulent claims, which can be a significant challenge, especially with the use of sophisticated methods to conceal fraud.
Claim assessment and processing: Assessing and processing claims can be a time-consuming and labor-intensive process, and may require a significant investment in technology and personnel.
Compliance with regulations: Insurance companies must comply with a wide range of regulations related to claims handling and processing, which can be complex and challenging to navigate.
Managing customer expectations: Insurance companies must manage customer expectations and provide clear and timely communication about the claims process and the status of claims.
Data management: Insurers must be able to collect and manage large amounts of data related to claims, including information about policyholders, claims history, and loss data.
Solution Overview
As technology advances, the banking sector must also adapt to improve its ability to detect cybercrime and spot anomalies.
Automated fraud detection can improve the accuracy of determining fraud risk, reduce false positives, and lower overhead costs.
Our proposed solution, OptiSol helped a finance company develop a machine learning-based fraud claims detection solution, which improved accuracy by 90% compared to manual processes.
The solution is able to identify claims that stand out as anomalies and the variables that cause them.
Data is analyzed to identify and understand abnormal data points and the variables that may cause anomalies.
Business impact
Improved accuracy: AI-based systems can analyze large amounts of data and identify patterns that may indicate fraud, which can improve the accuracy of fraud detection and reduce the number of false positives.
Increased efficiency: Automated fraud detection can reduce the need for manual review and investigation of claims, which can save time and improve efficiency.
Increased customer satisfaction: By detecting fraud quickly and efficiently, insurance companies can improve customer satisfaction by resolving claims faster and with greater accuracy.
Better data-driven insights: AI-based systems can analyze data to identify patterns and trends that can be used to improve fraud detection, risk management, and strategic decision-making.
Identifying potential fraud: Fraud detection systems can identify potential fraud and alert the company before actual losses occur.
