Leading Swiss insurance company

Detecting potential claim fraud among health insurance clients

Challenge

• Undetected fraudulent insurance claims may cause a significant blow to insurance companies’ revenues

Solution

• Implemented fraud scoring KPI’s together with visualisation
• Enabled multiple insurance companies to use the API to validate claims of their customers
• Ensured auditability and idempotency of the results

Impact

• Automated the fraud-flagging process
• Created tools allowing enhanced manual inspection of the most suspicious claims for multiple companies