A leading US-based supplemental health insurer partnered with Coforge to proactively combat rising claim fraud amid increasing transaction volumes. The client’s existing manual and rule-based detection systems were no longer sufficient—delaying identification of suspicious activity and contributing to financial losses.
Coforge implemented a scalable, AI-powered fraud detection solution that enabled real-time risk scoring and early anomaly detection. By leveraging advanced techniques such as ensemble modeling and Graph Neural Networks, the insurer gained the ability to flag high-risk claims instantly, shifting from retrospective fraud analysis to proactive, real-time intervention.