Detect Potential Fraud through Anomaly Detection

Insurance fraud drains significant resources. LLMs enhance fraud detection by analyzing claims data (structured and unstructured) for unusual patterns, inconsistencies, or known fraud indicators that might be missed by human reviewers or rule-based systems. They can cross-reference information across claims and external databases to spot connections or discrepancies. An LLM might flag a claim with unusually high medical bills for a minor reported injury, prompting further investigation. AI-powered systems have helped reduce fraudulent claims by around 20%.