Insurance Fraud

Delivering a category-defining vision for next-generation counter fraud and financial crime prevention - combining agility, scalability, and proven impact to help insurers lead with data-driven intelligence.

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CHALLENGE

Insurance fraud continues to erode profitability

As fraudsters and the technology they use becomes more sophisticated and interconnected, traditional rules‑based and siloed approaches struggle to keep pace — creating blind spots, false positives, and slow investigations that results in increasing loss ratios, operational costs, and customer friction.

70%

In P&C, claims paid typically absorb around 70% of premiums earned

Source: NAIC

20%

An estimated 20% of insurance claims are fraudulent

Source: Forbes

WHY QUANTEXA

Building A Market-Leading Vision For Decision Intelligence

Delivering a category-defining vision for fraud and financial crime prevention - combining agility, scalability, and proven impact to help insurers lead with data-driven intelligence.

More Control
Desire to take more control of fraud detection and analytics strategy
Build Your Own
Leverage leading in-house data and technology capabilities to "build your own" with full self-sufficiency
Accelerated Journey
Expedite your journey by bringing world-class digital-ready tools with flexible analytics
Market Leading
Maintain leading position in fraud with category-leading capabilities such as entity resolution, graph and streaming integrations
Future Proof
Future-proof fraud protection across the value chain — extensions to internal etc.

HOW WE SOLVE IT

Next generation counter-fraud capabilities

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Unify your data estate

Unify internal systems and enrich with external data (corporate registries, industry claims etc) to understand risk holistically

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Create a customer and counterparty view

Connect data to reveal hidden relationships across customers, claimants, providers, assets, and organizations

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Apply proven fraud analytics

Detect even the most sophisticated claims fraud with scorecards grounded in contextual data for higher accuracy and better prioritization

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Powerful investigation tools

Accelerate fraud investigations and uncover hidden relationships with more accurate contextual intelligence and AI decisioning

THE IMPACT

What we have achieved

$>3B

the amount of fraud Quantexa has helped organizations detect

75% reduction

in false positive alerts through enrichment

90% increase

up to 90% increase in fraud impact savings

3% improvement

in loss ratios from improved claims segmentation

WHERE WE HELP

Our Insurance Fraud solutions

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Application and Underwriting Fraud

Identify fraud across the full customer lifecycle and all distribution channels.

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Claims, Billings, and Provider Fraud

Block fraudulent payments and stop claims leakage across the claim, billing and payment lifecycle.

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Internal Fraud Detection

Detect insiders engaged in defrauding the insurance organization or the firm’s customers.

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Complex Investigations

Perform complex investigations across all data to identify new and unknown risks.

Why Quantexa

Increased counter fraud effectiveness and efficiency across the enterprise

Improve loss ratios
Reduce leakage, prevent fraud, and deliver indemnity savings, improving loss ratios by 1-3%
Reduce customer friction
Enhance customer experiences and accelerate approvals for genuine borrowers
Augment operational efficiency
Power touchless processing for straight-through claims and streamline analyst workflows
Transformation across the enterprise
Power transformation across the enterprise with Customer Intelligence, FinCrime, and Data Modernization solutions using the same data foundation
Solution Overview

Get an overview of Quantexa’s Fraud, Risk Management and Security solutions

category-leading technology

Our Decision Intelligence Platform

Build a single view of data and create a culture of confidence around critical decision-making that protects, optimizes, and grows your organization.

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Quantexa AI

Boost productivity and effectiveness with AI

Empower users to identify more fraud risk, faster with Q Assist, an embedded investigations Copilot, to access critical insights, automate alert triage, augment report generation and streamline report filing.

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outcome-driven solutions

Decision Intelligence solutions built on our platform

FAQs

Do you provide real-time capabilities to prevent fraud?

A new contextual approach is required to improve fraud prevention, detection, and investigation. Market participants have raised challenges with using real-time capabilities which are missing risk and blocking legitimate payments or adding friction, which is impacting the customer experience.  

However, Quantexa can detect suspicious transactions in near-real-time and alert to ensure high-risk transactions can get immediate attention. Quantexa can also augment with existing technology to provide additional context to illuminate high-risk transactions or provide confidence through mitigating factors that the transaction is legitimate and non-fraudulent. 

What out-of-the-box models do you have?

Detection Packs for fraud deliver higher true positives, lower false positives. For additional coverage, we have knowledge and IP, but we will work with your teams to develop using your own data. 

DRIVE INDUSTRY TRANSFORMATION

Speak to an expert

Protect, optimize, and grow your organization with Decision Intelligence. More is possible with the right data in the right context.

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