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.
Insurance Companies/Hospitals: