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Status
The solution is deployed in production at Aioi Nissay Dowa Insurance, where it contributes to deterring fraudulent claims by suspicious contractors. It is the highest-performing fraud detection model jointly developed by OXFIDA and Aioi Nissay Dowa Insurance, delivering the greatest operational impact across their fraud analytics portfolio.
In 2024, the solution received the Claims Initiative of the Year award at the Insurance Awards in recognition of its innovative application of AI to claims management. The model is continuously enhanced using newly accumulated claims data and suspicious contractors’ information and is retrained approximately every three months to adapt to emerging fraud patterns.
FLAGSHIP PROGRAMME
Post-disaster contractor fraud detection
Summary
Using more than 1.1 million property insurance claims and related datasets, we developed an AI system that estimates the likelihood of involvement by suspicious contractors or claims management companies.
The system produces a fraud-risk score together with an explanation of the prediction, enabling insurers to identify high-risk claims early while protecting genuine policyholders.
The problem
Following natural disasters, there has been a growing number of fraudulent contractors and claims management companies who solicit policyholders by offering to handle home repairs and insurance claims on their behalf, only to charge excessively high fees and repair costs. Insurers must identify such cases early, often with only limited information available immediately after a claim is submitted.
Solution
We developed an AI model that analyses historical claims and customer interaction data to identify patterns associated with fraudulent claims. The model generates a fraud-risk score and explains the key factors influencing each prediction, allowing insurers to identify potentially suspicious claims immediately after submission and prioritise investigations accordingly.
This enables the swift identification of priority investigation targets, facilitating the prevention of fraudulent claims and the protection of policyholders.