Fordel StudiosInsurance Fraud Detection Agent
Catches fraudulent claim patterns before adjusters waste hours on them.
The problem
being solved
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.
How this
agent works
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 |
- 01
Domain-trained
Tuned on your insurer's specifics, not a generic out-of-the-box model.
- 02
Audit-ready
Every output cites its sources, every decision logs its inputs.
- 03
Senior-built
Architected and shipped by senior engineers; no juniors learning on your matter.
- 04
Integrated, not bolted on
Plugs into your existing claims system, not a parallel tool.
Build this agent
for your workflow.
We custom-build each agent to fit your data, your rules, and your existing systems.
Free 30-min scoping call