Claim Fraud Analytics using AI ML Cognitive Services: 4-Weeks Implementation

Health Insurance firm and TPA’s are equipped with most Intelligent solutions to minimize the fraudulent claims. However, hospitals find deceitful methods to increase the claim amount to the most claimable percentage of the sum insured. Our solutions with its AI and ML capabilities set a track, identify, and rule out fraudulent claims.

Azure claim Fraud analytics solutions is a unified solutions built using Azure synapse and Azure cognitive service with the right essence of data ingestion, big data analytics, machine learning and data warehousing. Azure Synapse claims fraud analytics solution uses descriptive and predictive modelling by detecting anomalies and prioritizing possible fraud cases.

Features and Benefits:

• This solution can read and adjudicate huge no. of medical documents in different languages of MICROSOFT enabled services

• Finding fraud patterns that are hard to be identified by human intelligence or standard methods can be categorized and a new pattern will be created

• Identifying procedures which are not related or required to be done for specific diagnosis

• Using AI cognitive services of Azure such as OCR, Translator, and Text Analytics for Health, Document processing, and analysis will be very fast which aids in identifying fraud claims

• High-performance data warehousing in Azure Synapse Analytics is perfect for handling large claim data volumes

• Finding one claim fraud pattern which cannot be identified by human intelligence, using the Spark ML Capabilities of Synapse and Azure ML Studio, can save several lakhs and time

• We have added Power Platform capabilities, using PowerApps and Power Automate for actionable intelligence, so claims can be approved/rejected in one click directly from the Power BI report