Risk Detect for Insurance Fraud

Our solution helps automate insurance fraud detection with advanced, multi-layered analytics, offering separate workflows for claims and policy fraud, helping reduce false positives and delivering transparent, actionable insights.

Make your fraud detection smarter and more reliable

Detecting fraud manually or through simple business rules often leads to delays, missed insights and false positives. Risk Detect helps insurers simplify fraud detection across the insurance life cycle using advanced multi-layered analytics. By automating investigations and reducing false positives, insurers can respond faster and more accurately to both opportunistic and organized fraud, improving operational effectiveness and delivering greater economic benefits.

 

 

Boost fraud detection and effectiveness with multi-layered analytics and automation

Identify fraud in real-time with industry leading analytics

Leverage advanced analytics and machine learning to instantly help detect opportunistic fraud, policy misrepresentation and organized fraud networks. Uncover hidden connections and fraud schemes across business lines.

Streamline your fraud investigation process with automated data analysis

Improve fraud detection by combining your claims, policy and third-party data into an enriched set. Our system provides a single view, identifies suspicious activities and simplifies case assignments to help boost potential.

Advanced detection tools help catch fraud early to safeguard your business and policy holders

Detect fraud early in the claims lifecycle to help prevent fraudulent payments and reduce indemnity costs. By consolidating your claims, policy, and third-party data into a single view and automating investigating processes and tools, our platform improves cycle times and operational effectiveness.

Designed for today’s needs

Our solution uses multi-layered analytics, including risk indicators, generative AI, machine learning and third-party data. It helps reduce false positives, increases the quantity and quality of fraud referrals, and provides overall transparency and explainability into each analytic score.

Identify and visualize organized fraud networks, reducing manual work. By uncovering hidden connections across claims and policies, our system enables faster, more effective investigations, helping insurers act quickly.

Our AI-driven approach offers transparency and explainability. Our platform provides customizable, detailed fraud indicators with clear reasoning behind each score, helping insurers make informed decisions and support investigative workflows.

Combat Claims Fraud with Risk Detect: Advanced Analytics and Seamless Investigation Tools

Risk Detect for Insurance provides multiple features and capabilities consolidated into a single platform, with a holistic suite at your fingertips, underpinned by essential strong AI governance to enable unbiased, accurate detection throughout the life of a claim to reduce unnecessary indemnity cost. The Risk Detect platform integrates multi-layered analytics along with customizable, end-to-end investigation workflow features and functionality to enhance operational effectiveness for your investigation team.

Combat Policy Fraud with Risk Detect: Advanced Analytics and Seamless Investigation Tools

Risk Detect for Insurance is a leading defense against policy fraud. Our unified platform combines industry leading multi-layered analytics with strong AI governance to enable unbiased, reliable detection throughout the life of a policy to reduce the risk of policy misrepresentations. Enhance your team’s effectiveness with customizable, end-to-end investigation workflows and a holistic suite of tools, designed to safeguard your operations.

Connect with us

Let’s talk about how Risk Detect for Insurance Fraud can help you.

Frank Pinder

Managing Director, Insurance Fraud and Financial Crimes, PwC US

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Dennis Toomey

Director, Fraud and Insurance Crimes, PwC US

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