Why People Remain Crucial in Combating Insurance Fraud

11 November 2024 / 2 min read

The rise of artificial intelligence (AI) has many questioning its impact on our roles as humans, particularly as it becomes more accessible and popular. In insurance fraud, the increasing sophistication of these technologies, coupled with a rise in opportunistic fraud, seems to be creating a bigger problem. However, to tackle this issue it is clear that the role of human intervention will remain irreplaceable.

When looking at how to fight against the fraudsters, it is natural to examine the tools being used and understand their benefits. AI excels at identifying patterns, red flags, and quickly spotting anomalies in data. It can process and analyse vast amounts of internal and external data sets far faster than humans, but the crucial next step is beyond AI’s capabilities. Can we rely solely on AI outputs to make decisions? This is where human knowledge and judgement become the perfect partner in the fight against fraud, in addition to accountability for decisions made to customers.

The most effective approach to tackling insurance fraud is to utilise both technology and humans throughout the entire policy and claims lifecycle. Opportunistic and organised fraud are both on the rise, further complicated by the rise of ‘shallowfakes’ and deepfakes.

Early detection of fraud benefits both policyholders and insurers. It allows for smoother onboarding of genuine customers and reduces fraudulent payouts, enabling faster payment of legitimate claims. Technology such as digital media forensics plays a crucial role in uncovering fraudulent activity at all stages of the policy and claim lifecycle across all products. Real time identification identifies potential manipulation in submitted images and documents.

This is followed by human intervention for investigation, which is crucial for the proactive approach needed in the ever-evolving insurance fraud climate.

Verisk’s internal Claims Investigation Unit exemplifies the power of combining human expertise with advanced technology. Trained investigators leverage tools like predictive modelling and industry-leading data to identify high-risk claims. This allows them to analyse connections and suspicious patterns, ultimately disrupting fraudulent activity.

In the current economic climate, with fraud increasing at both opportunistic and organised levels, and with the additional dangers posed by the potential misuse of AI, a collaborative approach is necessary. The ultimate goal in the fight against insurance fraud is to detect and disrupt this activity. This cannot be achieved by technology or humans alone. The complementary skills of technology detecting fraud and humans investigating and making decisions creates a clear picture: the need for human intervention in this fight is fundamental.

See for yourself the technology we have developed in the fight against fraud. Find out more here.

The Human Touch: Why People Remain Crucial in Combating Insurance Fraud