Role of AI Solving Insurance Fraud & Claims Automation at scale

Artificial Intelligence‘s usages are increasing with leaps & bound in Insurance Sector [Life, Health, General & new-age shared /micro insurance]. Insurance sector has been for many decades and still uses legacy as its processes however it is rapidly changing. Artificial Intelligence [AI] stands to transform the insurance industry at fundamental levels from business model to value chain. It is important to find out use cases in industry than technology to make larger impact. In Insurance AI is critical in solving multiple use cases but fraud prevention and claims automation holds larger opportunity as well.

AI Role in Insurance

In 2017, Artificial Intelligence has shown its substance in various business verticals by rapidly creating controlled, digitally enhanced automated environments for maximum productivity. Apparently, Insurance companies, in particular, have a lot to gain from investing in AI-enabled technology that can enable in building digital sales processes, smart underwriting, claims risk analysis, automation, early claims detection, fraud detection & prevention, building new micro-insurance products, need based insurance products, operations automation and more.

Fraud Detection in Insurance

Frauds are of multiple types in Insurance and every sector of insurance is experiencing fraud issues. According to a recent survey by insurance institute of India, it is estimated that the number of false claims in the Indian industry is approximately 15 per cent of total claims The same report suggests that the healthcare industry in India is losing approximately US $100–150 Million incurred on fraudulent claims annually.

AI based Fraud Detection —

Overall entire industry across globe is losing about US $6B annually due to fraud cases. AI is helping insurance to fight fraud to go deeper in the processes, data, information, patterns and profiling and building predictive models. These predictive models alerts such kind of suspicious activities to reduce fraud.

Claims Automation & Assessment

Claims are core business vertical for every insurance company. Fraud mostly happens during claims actually. Globally there are 30% of the cases that appears as claims each year. Either it is health claims, motor claims, accidental claims, life claims, death claims, Business claims, Commercial claims and more. Average time for claims takes more than 7 days to 60 days and also causes higher costs of claims.

AI Claims Automation —

Customer do not buy policies due to fear of complex claims process and no outcome driven process. AI is greatly going to help claims processes for health claims, life claims, business claims, motor claims and more with self-driven claims process and instant claims payout. is one of the first platform that provides end to end claims automation, assessment and fraud prevention using AI technology and data driven insights. To know more visit:

This was originally published at Medium.