Page 29 - The Insurance Times March 2025

AI-Powered Investigation

AI-Powered

Investigation: The

missing link in India's

fight against Suvajit Sengupta

Chief Technology Officer
insurance fraud (A product of GEOGO Techsolutions)
Kriyam.ai

Every year, insurers lose 8-10% of their revenue to fraud, but they manage to thoroughly investigate
only about 1% of fraudulent claims. This ongoing issue continues because of significant gaps in
the current fraud detection and investigation practices.

I ndian insurance companies lose nearly ?30,000 crore an- The Challenges of Manual Investigation

nually to insurance fraud-a staggering figure. When you
Processes
consider that India's insurance penetration rate[5] is just
3.7%, far below the global average, this loss becomes
ciencies that plague their investigation processes. Unfortu-
even more alarming. Insurers lose 8-10% of their revenue to Insurance companies in India are no strangers to the ineffi-
fraud each year, yet they thoroughly investigate only about nately, the pace at which fraud schemes are evolving-be-
1% of fraudulent claims. This issue persists due to significant coming more sophisticated and complex-is outstripping the
gaps in current fraud detection and investigation practices. ability of fraud control units to keep up. Many insurers are
still relying on outdated, manual processes and legacy sys-
While checks are in place to control some types of fraud, tems, which only serve to slow down their response times
the more sophisticated schemes require highly coordinated further and reduce their effectiveness.
efforts between fraud control units (FCUs), field investiga- The growing challenges in fraud investigation are
tors, and sometimes even local authorities. However, FCUs
often lack the resources and infrastructure to handle the driven by several key factors:
sheer volume of investigations efficiently. As a result, i. Heavy reliance on manual processes: Manual docu-
mentation and paperwork make investigations slow and
scammers can exploit weaknesses in the system, allowing
cumbersome. Even relying on spreadsheets, web por-
many fraudulent transactions to slip through the cracks.
tals, or WhatsApp for data sharing increases errors and
This highlights the urgent need for a comprehensive fraud adds complexity.
investigation system that can aid FCUs with more efficient ii. Limited transparency and tracking: Without real-time
and streamlined field investigation to combat the evolving tracking and clear visibility into the investigation pro-
threat. In this article, I'll explore the key challenges insur- cess, insurers leave open many blind spots, leading to
ers face in tackling fraud and discuss potential solutions, potential frauds slipping through the cracks.
including the role of artificial intelligence and optimizing iii. Vendor collaboration complexities: Lack of streamlined
field operations to stay ahead of the fraud curve. communication channels with external surveyors and in-

26 March 2025 The Insurance Times