Motor claims fraud and detection model Qorus Innovation in Insurance Awards 2022

Fraudulent claims are a huge loss for the insurance business. TATA AIG believes in just and fair settlement of claims in a cost-efficient manner by a proactive and time-bound approach but also curb any kind of unethical practice. However, until recently past, suspicious claim investigation was manually managed through process and training. With rapid expansion and growth, there was a need to shift from this subjective approach to a more objective granular and AI/ML approach augmented by our domain expertise. This solution uses historical data to build an AI-based system supplemented with human experience (claims team) to score individual claim transactions. The solution has benefited the claims team by automating the workforce management basis of the score which resulted in an approximately 30% lift in repudiation due to fraudulent reasons.