AI Fraud Detection Engine
ML module for suspicious health insurance claims, fraud risk scoring, and claim review decisions.
Overview
A focused fraud analytics module that scores claims, surfaces anomalies, and supports human reviewers with audit-friendly prediction logs.
Key features
- ML models for claim fraud scoring.
- Training and prediction on historical claim data.
- Detection of unusual amounts, repeated patterns, provider anomalies, and suspicious behavior.
- API-first integration with existing insurance cores.
- Prediction logs for auditing and model improvement.
- Dashboard-ready outputs for risk monitoring.