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Health insurance/Fraud management
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Fraudulent claims can cause huge losses to insurance companies and policy holders. However, human inspections and heuristic rules may not always be able to identify fraud in large sets of insurance claim data, considering the diversity and complexity of the fraud schemes. With data analysis, AI tools and techniques can be used to detect fraud in large sets of insurance claim data. They can then generate alerts when any insurance claim is classified as fraud based on some predefined criteria.

Benefits
  • By observing detailed invoices and justifications before proceeding to payment, it saves money 
  • Decreases the burden of document verification thereby decreasing the time and faster service
Implementations

Insurance Companies/Hospitals:

  • Offer personalized customer service 
  • Manage transaction processing
  • Prevent fraud
  • Educate customers
  • Send reminders
  • Lower employee turnover
  • Upsell and cross-sell
  • Learn about customer sentiment