Catches fraudulent claim patterns before adjusters waste hours on them.
Fraudulent claims compound losses. Detection traditionally happens at two extremes — automated rule-based scoring (high false positive rate, blunt) or human SIU investigation (slow, expensive, only triggered after the fact). The middle ground — surfacing claims that warrant a closer look earlier in the process — is where most insurers leak money.
We build a fraud detection agent that scores incoming claims for anomaly patterns the moment they arrive — comparing against historical claim graphs, claimant/provider networks, and ring-fraud signals. Adjusters receive a fraud-likelihood score with the specific reasons surfaced, not a black-box flag. Lifts SIU referral quality and reduces wasted adjuster hours on obviously fraudulent claims.
Custom-trained on your claim history and fraud patterns. 8-10 weeks for first deployment, with continuous retraining baseline.
A mid-size insurer wires the agent into its first-notice-of-loss pipeline. Each incoming claim gets scored against the carrier's own historical graph and claimant/provider network. Adjusters see a likelihood score with the specific reasons surfaced; SIU referrals shift earlier in the lifecycle and arrive with better evidence packages.
| Metric | Before | After |
|---|---|---|
| Time to surface high-risk claims | Days to weeks (post-investigation) | Minutes from claim intake |
| SIU referral quality | High false-positive rate from rules engines | Reasoned scores with evidence trail |
| Adjuster hours on clearly fraudulent claims | Same as legitimate claims | Routed early; minimal adjuster time wasted |
Tuned on your insurer's specifics, not a generic out-of-the-box model.
Every output cites its sources, every decision logs its inputs.
Architected and shipped by senior engineers; no juniors learning on your matter.
Plugs into your existing claims system, not a parallel tool.
Anonymized work with hard metrics — NDA-bound, no client names.
72%
Processing Time Reduction
94%
Classification Accuracy
1.2 days
Avg Processing Time
“The classification consistency was the biggest operational win. Adjusters are now working from standardised severity assessments rather than making independent calls on damage they have never seen before.”
— Head of Claims Operations, Motor Insurance Division
We custom-build each agent to fit your data, your rules, and your existing systems.
Free 30-min scoping call
Fordel Studios