The Challenge
A leading US supplemental health insurer was facing a surge in fraudulent claims along with a dramatic rise in transaction volumes, which made it increasingly difficult to detect the signal against the noise.
Manual investigations couldn’t keep up, and rule-based systems were not intelligent enough to detect increasingly sophisticated fraud schemes.
The result was slower detection, missed red flags, and ultimately, financial losses. They needed a scalable, AI-driven solution that could proactively identify suspicious claims in real-time and reduce their reliance on retrospective analysis.
