Insurance Claim Fraud Risk

Using all the data available at the time of claim including details about the policy, the policyholder, and the claim, Gilela uses an AI solution that prioritise which claims are most likely to be fraudulent and which are almost certainly not.

The team prioritised the claims that are likely to be fraudulent and invested more effort to find the fraud. The claims that the AI solution identified as not being fraudulent are automatically approved without protracted investigation.

The Benefit

This solution reduces wasted effort and cost investigating claims that are not in fact fraudulent.