Claims Fraud Detection in Real Time – Hybrid AI for Smarter, Faster Decisions
Discover in our paper how RiskShield detects insurance fraud in real time with Hybrid AI. Stop fraud faster and protect margins with explainable automation.
Claims Fraud Detection
RiskShield for Claims Fraud Detection – Real-Time Scoring. Real Impact.
RiskShield enables insurers to detect and prevent fraudulent claims in real time by using a Hybrid AI approach that combines rule-based logic with machine learning to accelerate claims handling, reduce false positives, and empower teams with full transparency and control.
Trusted by Industry Leaders
Join our prestigious customers – trusted names in the insurance sector.
Value Proposition for Insurers
- Faster Fraud Detection
Score every claim in real time to identify risk immediately.
- Operational Efficiency
Automate workflows and route legitimate claims straight to fast track.
- Explainable AI Decisions
Gain full transparency and control with interpretable models.
- Reduced Workload
Let your teams focus on real fraud, not false alarms.
HOW RISKSHIELD DETECTS AND PREVENTS CLAIMS FRAUD
RiskShield combines rule-based logic, machine learning, and automation to detect and prevent claims fraud in real time, ensuring accuracy, transparency, and operational efficiency across the insurance lifecycle.
1. Hybrid AI Scoring
Combines expert rules and machine learning to deliver accurate, real-time claim scoring and fraud probability assessments.
2. Explainable Decisions
Ensures full transparency with auditable logic, traceable decision paths, and clear reasoning for every automated action.
3. Automation at Scale
Accelerates workflows through automated case handling, routing, and payout management, minimizing manual effort and delays.
4. Connected Insights
Links claim data, entities, and behavioral patterns across portfolios to uncover hidden relationships and prevent repeat fraud.
With RiskShield, claims fraud detection becomes faster, smarter, and more transparent – helping you protect margins and customer confidence.
Fast, reliable Results
After just a few weeks of use, RiskShield achieved a threefold increase in fraud detection – from 1 % to 3.6 %, even with minimal input data and no external sources. This demonstrates the power of RiskShield’s AI-driven scoring to deliver reliable results from day one.”
How RiskShield Supports Your Teams
Fraud detection in insurance claims involves multiple teams working with different data sources and priorities. RiskShield streamlines collaboration across departments by providing real-time insights, automated scoring, and explainable decisions, empowering every team member to identify and manage fraud efficiently.
SMART CLAIMS FRAUD DETECTION
RiskShield for Claims Fraud Detection empowers insurers to identify suspicious claims early, reduce false positives, and accelerate claims handling.
With real-time analytics and explainable AI, RiskShield detects hidden fraud patterns across channels and ensures fast, transparent decisions that protect both customers and profitability.
Download our dedicated brochure for more insights.
DISCOVER OUR Information Material for Insurers
Find more interesting info papers, brochures, and other downloadable assets on RiskShield in our section Expertise.
Ready to transform your claims fraud detection?
Let’s talk about how RiskShield helps you automate investigations, improve detection accuracy, and deliver faster, more transparent claims processing.
Oliver Walczak
Team Lead Insurance Solutions | Risk & Fraud
