A Digital Expert can be trained in this combination of skills to automate fraud detection. For example:
Problem Solving – the Digital Expert could monitor each claim and assess it against company policies to identify when it is likely to be fraudulent or contravenes with company policies. For example – a company’s policy might be to question any claim that was made within 5 days of the insurance policy being taken out.
Machine Learning – the Digital Expert could analyse all the previous cases of fraud and identify the patterns that would indicate fraud and apply them to each claim. For example – machine learning might identify that when there are multiple injury claims for a single claim it is likely to be fraud. Machine learning delivers an accurate probability score for fraud which can drive a corporate action; for example, a score over 25% may always be referred to the fraud team.
Collaboration – the Digital Expert could advise an assessor or hold a conversation directly with the claimant to gain further information relating to the claim. This would enable capture of information not provided in the claim form – did they sign themselves off work? AI services such as sentiment analysis could help further in detecting how genuine the claimant sounded.