RiskShield enables insurers to detect and prevent fraudulent claims in real time by combining Hybrid AI, rule-based logic, and continuous learning, reducing false positives, accelerating claims handling, and empowering teams with full transparency and control.
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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.
In a proof of concept, RiskShield achieved a threefold increase in fraud detection – from 1 % to 3.6 %, even with minimal input data and no external sources.
→ Demonstrating the power of RiskShield’s AI-driven scoring before full-scale rollout.
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.
Find more interesting info papers, brochures, and other downloadable assets on RiskShield in our section Expertise.
Let’s talk about how RiskShield helps you automate investigations, improve detection accuracy, and deliver faster, more transparent claims processing.
Oliver Walczak
Solution Owner Insurance - Risk & Fraud
