The German insurance industry is facing the challenge of identifying and stopping fraudulent insurance claims. The facts speak for themselves:Each year, over €50 billion are paid out in damages for indemnity and accident insurance claims alone. It can be assumed that at least every tenth claim is fraudulent in nature. This is why an active fraud detection system is an integral component of the initial claims processing procedure, even in industries with so-called large quantities of damages. Here, the spotlight is on the detection of new fraud patterns. Approaches based on artificial intelligence (AI) enable insurers to identify new types of abuse patterns quickly and to initiate the corresponding countermeasures.
adesso works together with you to develop a solution that detects and evaluates insurance fraud by applying a specialist set of rules that is intuitive to maintain and integrating external data sources. It also provides reasons for this evaluation. Action recommendations are generated that enable the claims processor to continue processing the suspected case in a way that optimise resources. Expanding this module with AI-based approaches allows the fraud detection process to be shaped efficiently and agilely. As part of this, explainable artificial intelligence (XAI) ensures that the use of artificial intelligence has a high degree of acceptance within the insurance company.
While our fraud detection model for your insurance company can represent the starting point for the joint implementation of a personalised, efficient fraud detection system, we can also use our comprehensive experience in operating and strategic area of claims management to help optimise your internal fraud processes.
Our teams combine expertise with regulatory knowledge and technological skills. We support all modern IT infrastructures and platforms such as open source (JAVA), Microsoft technologies, cloud services and mobile technologies as well as agile (SCRUM, KANBAN, SAFE) or traditional (V-model) methods. This allows us to respond to your individual project requirements.