Carpe Data Claims Solutions Qorus-NTT DATA Innovation in Insurance Awards 2026

Claims leaders face escalating fraud, social inflation, and limited investigative bandwidth, yet in the current landscape, approximately 5% of open claims receive manual review, leaving critical blind spots as fraud tactics outpace legacy tools. Carpe Data’s Claims Solutions were built to eliminate these blind spots by continuously assessing every injury claim from first notice of loss and preventing fraudulent or exaggerated losses before they escalate into high-severity losses and costly litigation.

At the core of Carpe Data’s Claims Solutions is a new unified AI decision layer, the Claims Reasoning Engine. This purpose-built intelligence surfaces and analyzes online evidence related to a claim, and explains the reasoning behind its insights. This approach reduces false positives common in other social media investigations and supports consistent decisions by tying every output back to what was found, where it was found, and why it matters. The Claims Reasoning Engine serves as the foundational intelligence engine behind Carpe Data’s suite of Claims Solutions: Online Injury Alerts and Investigative Reports.

Used by 10 of the top 20 carriers, Online Injury Alerts is Carpe Data’s proactive injury claims assessment service that continuously reviews every injury claim, using AI to surface fraud indicators that may be missed by manual review or static models. This approach gives carriers visibility across 100% of claims while delivering evidence-based, human-verified alerts that prioritize quality over volume. As a result, carriers are achieving 5–10x ROI, uncovering 20x more fraudulent activity, and saving ~240 hours in manual review per week. Online Injury Alerts combines AI-driven intelligence from the Claims Reasoning Engine with clear evidence and recommended next steps for every alert. For claims that require a closer look, Carpe Data’s Investigative Reports offer fast, comprehensive online investigations that combine AI data discovery and human analysis. While standard vendors take 1–3 weeks, Investigative Reports delivers actionable results within 48 hours, with 99.98% accuracy and a 6+ month history of activity. Powered by Carpe Data’s Claims Reasoning Engine, Investigative Reports use automated data discovery to support human analysis, delivering thorough investigative insight at a lower cost than traditional methods.