Solution Financial Services
AI Fraud Detection for Insurance Claims
An AI fraud detection platform for insurers that uses graph analytics and NLP to find organized fraud patterns across insurance lines.
4xFraud ring detection rate
+55%Investigator productivity
Typical outcomes for this kind of engagement. Results depend on your data and starting point.
THE CHALLENGE
Rules engines catch crude, individually implausible claims but miss organized rings that operate across claimants, repairers, medical providers and intermediaries.
- Rules engines missing organized fraud
- No visibility of cross-line fraud patterns
- High investigator workload with low conviction rates
OUR APPROACH
CloudGate builds a fraud detection platform that combines anomaly detection, graph-based network analytics and NLP over claim narratives, using Azure Machine Learning, Microsoft Fabric and Azure OpenAI.
- Graph-based network analytics exposing organized rings
- NLP analysis of FNOL narratives for inconsistency and deception indicators
- Anomaly detection across claim, payment and provider behavior
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