India's largest platform and marketplace for GCCs & AI

Sign in

India's largest platform and marketplace for GCCs & AI

3AI Digital Library

Claims Fraud Detection for P&C Insurance

3AI August 15, 2020

Leading Personal Lines Insurance Carrier in NE of US

Problem Statement

  • Basic business rules for fraud detection and prevention was in place and the need for improving their fraud detection and prevention tools was considered
  • A POC was developed to analyze Customers’ claims data to provide trends and patterns of suspected fraudulent transactions

Analytics Led Approach

  • Given are high level process steps which were followed:
    • Sensitive data encryption
    • Load the data from
    • multiple sources Logistic Regression Model creation
    • Data cleansing ; Data transformation; Business Significant variables deduction
    • Distribution analysis
    • Correlation analysis
    • Multi- dimensional Analysis
    • Fraud analysis through data profiling
    • Identify key suspect indicators which indicated possible provider frauds

Business Impact

  • Designed a proof of concept whereby Customers’ auto claims data for specific calendar year were analyzed and trends and patterns from analysis  were presented
  • The solution helped to identify the potential losses due to fraud or suspect claims and thereby helped to reduce claims leakage to a great extent

Critical Success Factors

  • $ 3.5 million potential losses were identified due to potential suspects
  • $ 600 k of potential losses were identified due to potential suspects with fortune coverage

    3AI Trending Articles

  • CES 2021 conference stress importance of security education

    Experts at the CES 2021 conference stress importance of security education The “second age” of quantum computing is poised to bring a wealth of new opportunities to the cybersecurity industry – but in order to take full advantage of these benefits, the skills gap must be closed. This was the takeaway of a discussion between […]

  • Property Registration in Karnataka to use Blockchain Technology

    Property registration in Karnataka is all set to become more secure and hassle-free, with the state government developing a system based on blockchain technology for online property documentation. The new system, developed in collaboration with IIT-Kanpur, promises an immutable electronic storage of property data through blockchain. In other words, data once stored cannot be changed, […]

  • Blockchain-Based Stock Exchange in Japan by 2022

    The exchange reportedly planned by SBI and SMFG is expected to be the first of its kind in Japan. SBI Holdings has reportedly partnered with Sumitomo Mitsui Financial Group (SMFG) to launch a digital stock exchange slated for spring 2022. SBI and SMFG are expected to launch the platform in Osaka to compete against the […]

  • 2020 marked a “turning point” for Cybersecurity in Australia

    Australians are on high alert about the threat of cyber attacks following Prime Minister Scott Morrison’s warning in June that Australia was targeted by a sophisticated “state-based” cyber-attack. It was, according to the Australian Cyber Security Centre (ACSC), the most significant and coordinated cyber-targeting against Australian institutions to date. The Prime Minister said while such […]