Our advanced Fraud Detection & Prevention platform is designed to safeguard your insurance processes through AI-powered solutions. It provides real-time identification of fraud patterns, uncovering fraudulent nexus among patients, doctors, hospitals, TPAs, and agents, ensuring that every claim is thoroughly scrutinized. The platform supports AI-based analysis, rule-based checks, and includes a human-in-the-loop feature to handle suspicious cases effectively.
Key Features
Fraud Detection & Prevention
Detects cashless and post-hospitalization fraud by identifying fraudulent links between patients, doctors, hospitals, and third-party agents.
Automated Claim Classification
Utilizes fraud risk scoring to automatically categorize claims as Genuine, Suspicious, or Fraudulent in real-time, improving claim management efficiency.
Explainability & Compliance
Ensures transparency with SHAP model explanations, making fraud decisions easier to understand for insurance auditors and regulators.
Low-Latency Predictions
Optimized for real-time inference using lightweight models that deliver fast, accurate predictions with minimal latency.
Mobile-Responsive UI & Omni-Channel Access
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Chatbot Interface: Provides an intuitive, user-friendly design that simplifies fraud detection interactions.
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Device Compatibility: Fully responsive, working seamlessly on laptops, mobiles, and tablets.
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API-Ready: Easily integrates into web portals, mobile apps, and third-party platforms.
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WhatsApp Integration (Pilot Mode): Allows fraud detection assistance via WhatsApp, making the solution accessible and easy to use for all stakeholders.
Real-Time and Batch Support via RESTful API
Offers flexible real-time and batch processing capabilities through a secure and efficient RESTful API, ensuring smooth integration into existing workflows and systems.
Why Choose ClaimAsist?
This solution ensures greater transparency, quicker decision-making, and helps mitigate fraud risks across the entire claims process, driving operational efficiency and compliance for insurance companies