Fraud Detection Bot

This is the Fraud Detection Bot, a native-AI driven solution that detects fraudulent workers' compensation claims and enhances the capabilities of insurance adjustors.

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Theme- Insurance Industry

Problem Statement: Workers' compensation claim fraud contributes significantly to the $40 billion insurance frauds per annum. A significant impact of COVID-19 has been the ‘Work from home’ culture. This presents new challenges to insurance companies as validation of claims from employees working at home is quite a challenging task.

Inspiration: The inspiration behind this solution was to make our contribution to the community during and post-COVID. Automation Anywhere's IPA technology has enabled us to employ the most sophisticated digital technologies to solve problems. Additionally, our team has representation from Europe, the Middle East, and Asia and this allowed us to bring our different perspectives and skills on the table.

Solution: Our solution, the Fraud Detection Bot is an intelligent process automation solution that leverages machine learning blocks such as natural language processing and computer vision to detect fraudulent claims. The solution is advanced in capabilities to extract information from unstructured documents and communicate with third-party sources for verification purposes. Based on the extracted information, the bot calculates a Fraud Score and generates the next action steps for claims adjusters. Claim adjusters can use the 'human-in-the-loop' feature of the solution to interact with the bot by viewing high-level insights and claims-specific information.

The bot has been designed with digital building blocks and uses APIs and python scripting. The Automation Anywhere IPA technology orchestrates the whole process allowing for end-to-end automation. The modularity in the design of the solution allows for quick and easy upgrades to the solution based on the insurance company preferences.

Challenges: The biggest challenge in implementation was an initial lack of understanding about the insurance domain, however, after reaching out to some connections in the insurance industry, we were on track with a better idea about the problem.

Impact: The impact of Fraud Detection Bot is not just limited to the current situation. Post COVID-19, we see that a lot of employees will continue to work from home and the Fraud Detection Bot will play an instrumental role in detecting fraudulent claims. The Fraud Detection Bot empowers insurance claims adjuster teams to identify fraudulent claims in an intelligent manner.

  • Leverages AI tech stack
  • Comprehends unstructured information
  • Generates Fraud score and next action steps
  • Facilitates bot-human interaction
  • Results in faster and error-free processing
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