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

  • Future Proofing GCCs

    For a while now, India has been driving back-office functions for some of the large enterprises across the world. However, over the past few years, it has taken giant strides towards becoming the innovation hub of the world, by adding strategic value to multi-billion-dollar businesses from around the world, through Global Capability Centres (GCCs) based […]

  • Transforming Customer Experience in Contact Centers using AI

    Author: Sudha Bhat, AVP – Customer Analytics, Genpact Modern customers are conscious buyers and do not settle for less. The pandemic has further emphasized the need to provide an exceptional customer experience. Customer support is one of the critical touchpoints to drive experience. It is even more relevant in today’s super competitive digital era, where […]

  • Digiboxx plans to hire 5,000 engineers

    Digiboxx is also aiming to have 10 million users in the next three years Digiboxx has started offering up to 20 gigabyte (GB) of free online storage in which an user can store and share file size of up to 2 GB New Delhi: Online file storage and sharing services startup Digiboxx on Tuesday said […]

  • Unleashing Agentic AI: Maximizing ROI with Autonomous Data Solutions

    Featured Article Author: Saurabh Kaushik, IBM In recent years, AI has fundamentally transformed businesses by enhancing customer engagement, streamlining processes, and improving decision-making. Now, a new phase of AI, known as Agentic AI, is emerging, which enables autonomous decision-making and action-taking capabilities. For business leaders and AI enthusiasts, this shift introduces exciting opportunities for innovation […]