Use Case • Insurance Fraud Prevension
Detect anomalies, identify suspicious behavior, investigate fraud cases, and manage your fraud operations from a single platform. AITECA combines document AI, data analytics, and collective intelligence to protect honest policyholders while safeguarding your organization's reputation.
Insurance fraud affects far more than insurers' financial performance. It also increases costs for honest policyholders, who ultimately bear the financial burden. As fraudulent documents become increasingly sophisticated, generative AI accelerates document forgery, and fraud attempts continue to rise, insurers must strengthen fraud controls without compromising customer experience or slowing operational processes.
According to ALFA, detected insurance fraud increased by 30% in a single year. It now represents nearly €1 billion and accounts for 5–7% of collected premiums and contributions.
Our Response
Detect up to 3× more fraud without adding workload for your teams.
Medical invoices, reimbursement documents, identity documents, and supporting evidence can now be altered—or entirely generated—in just minutes. 65% of detected fraud cases involve a falsified document, making advanced document authentication essential for fraud investigation teams.
Our Response
Every document is automatically authenticated as soon as it is received.
Fraud teams must review a growing number of alerts while documenting every investigation and decision. They need tools that centralize alerts, streamline investigations, and provide complete auditability throughout the fraud management process.
Our Response
Centralize every alert and maintain 100% traceability for audits and compliance.
INFOGRAPHIC
Documentary Fraud: the new systemic risk of insurance
From document collection to investigation management, AITECA centralizes the entire fraud prevention process within a single platform. Alerts are detected, qualified, documented, and managed seamlessly—without disrupting workflows or requiring multiple disconnected tools.
Supporting Document Collection
Multichannel AI Detection
Alert Qualification
Investigation
Decision & Resolution
Reporting & Performance Management
Step 1 / 6
Documents submitted by policyholders, healthcare providers, repair shops, adjusters, or third parties are automatically centralized to build a complete case file before analysis begins.
Key Features
Step 2 / 6
AITECA combines document AI, collective intelligence, data mining, and human reporting to identify the highest-risk cases. More than 150 built-in controls and 130+ document types are available out of the box.
Key Features
Step 3 / 6
Each alert is enriched and contextualized, allowing investigators to quickly focus on the cases that require deeper analysis.
Key Features
Step 4 / 6
Investigators work within a secure, centralized environment to review supporting documents, document findings, and consolidate evidence throughout the investigation.
Key Features
Step 5 / 6
Investigation outcomes are structured, documented, and secured to reduce operational risk and simplify future audits and regulatory reviews.
Key Features
Step 6 / 6
Fraud managers gain a consolidated view of fraud operations—including processing times, fraud types, sanctions, costs, and savings—to measure performance and identify emerging trends.
Key Features
A shared, cross-insurer fraud intelligence database that accelerates claims processing, reduces false positives, and enables more secure decision-making
No insurer has a complete view of fraud risk. The M+ Database compares every document against a shared repository of document fingerprints, uncovering suspicious reuse and fraud patterns that can only be detected through cross-insurer intelligence.
As fraud attempts and claim reimbursements continued to rise, CCMO chose to combine human expertise with advanced technology. By deploying AITECA, the mutual insurance provider established a dedicated fraud unit to detect more fraud, streamline investigations, and strengthen protection for its policyholders.
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