+91 8160248065
804 Landmark, 100 Feet Rd, opp. Seema Hall, Anand Nagar, Ahmedabad
sales@einnosystech.com
einnosystecheinnosystech

Insurance Company Reduces False Claims with Advanced Data Analytics

  • Hartford
  • Insurance
  • 20 weeks
  • B2C
  • Python, R, Apache Spark, Tableau, Databricks, AWS

Project Brief

A popular insurance firm wanted to use data analytics, to prevent false claims, increase underwriting accuracy, and optimise pricing models. The objective was to create a comprehensive data-driven strategy for risk assessment and detecting fraud.

Client Background

 The company, which is a large supplier of casualty and property insurance, had substantial issues due to false claims and erroneous risk assessments. Traditional methods of identifying fraud depended mainly on manual inspections and rule-based systems, both of which were time-consuming and error-prone.

Key Challenges:

The organisation has accumulated a massive quantity of claims data, insured data, and external data sources, which renders it impossible to analyse and draw useful conclusions.
Data were stored in various systems and formats, necessitating substantial cleaning and preparation before analysis.
Creating reliable risk models to predict the probability of future claims and adjust pricing policies accordingly.
Identifying small trends and abnormalities that may suggest fraudulent behaviour.
Ensure compliance with data privacy laws and industry standards.

Solution:

1. Discovery and Planning

We worked with the insurance company's data science and fraud detection teams to obtain a thorough grasp of their current procedures and difficulties. We carried out a complete data audit, selected key aspects for investigation, and created an organised data analytics strategy.

2. Development

Our skilled data analytics team used Python's Pandas and Scikit-learn tools to create predictive models. We used Apache Spark on Databricks for distributed computing and scalability, which allowed us to analyse large datasets effectively. We created algorithms for anomaly detection to find unexpected trends in claim data that may suggest fraudulent behaviour. The models were installed on AWS, including services such as S3 for storage of data and Redshift for data warehouses.

3. Implementation

We incorporated the data analytics platform into their current claims processing system. This included creating data pipelines to import claims data, training models on historical data, and deploying the models in a production environment. We also gave fraud investigators extensive training on how to utilise the platform to detect and probe suspected fraud cases.

Tools & Technology Used

Python

Programming Language

Tableau

Data Visualization

AWS Logo

AWS

Cloud Services

Apache Spark

Data Processing

Features:

Fraud Detection

Fraud detection involves identifying possibly fraudulent claims through abnormalities in claim facts, policyholder behaviour, and external data sources.

Risk Assessment

Risk assessment predicts future claims for individual policyholders, leading to correct pricing and underwriting choices.

Real-Time Alerts

Real-Time notifications: Automated notifications for questionable claims activity allow for early investigation and response.

Explainable AI

Explainable AI offers straightforward explanations for model predictions, increasing confidence and openness in decision-making.

Customizable Dashboards

Customisable dashboards enable users to analyse claims data, track model performance, and spot patterns.

Values Delivered:

The software drastically decreased the amount of false claims paid out, save the company millions of dollars every year.
Accurate risk models resulted in improved pricing decisions, ensuring that premiums reflected risk levels.
Real-time analytics helped the organisation to recognise and investigate fraudulent behaviour faster, resulting in reduced losses.
Automated procedures and data-driven insights helped to streamline operations and increase operational efficiency.

Categories