Insurance fraud costs the economy over $2 billion per annum – our ML model helped a leading insurance provider to detect fraudulent claims

Our solution analyses large volumes of claims data in real-time, to detect suspicious patterns / anomalies, allowing the prevention of fraudulent claims from settlement process

What we were solving for

Quality of detection processes: Insurance companies struggle to detect fraudulent claims, given the use of sophisticated methods to conceal fraud and quantum of data to analyse

Resourcing: Assessing and processing claims is a time-consuming and labor-intensive process and requires a significant investment in technology and personnel. Furthermore, insurance companies must comply with a wide range of regulations related to claims handling and processing

OptiSol solution

Created an unsupervised learning model that would consume data provided in an insurance claim and then flag if suspicious – a classification model, trained and tested with historical data

Isolation Forest and SVM (Support Vector Machine) model was constructed to identify claims that stood apart as anomalous

Data is analysed to examine and check for abnormal data points, as well as to comprehend variables that may cause anomalies. e.g., the duration between the accident date and the claim reported date

Driver specific analysis is automated in which the license class, experience and vehicle-based restrictions are considered

What our Clients say

"They are very responsive and able to shift focus quickly as we have needed it for business reasons."

"They [OptiSol Business Solutions] have been very friendly and they kept up with the work. They did the job as we had discussed and as everything was arranged."

“I can't speak enough about how pleased I am with their process; it was seamless and efficient.”

"What impressed me the most was their willingness to go above and beyond what was asked."

"We're constantly impressed with their speed and quality of the development that they achieve on a consistent basis."

The best part about working with OptiSol Business Solutions is their commitment to being readily available to their partners. They’re even willing to work into late hours of the night depending on time differences. The solution they produced has already doubled efficiency levels.