The use of AI agents for insurance companies has become essential for fraud detection. It is well known that these criminal practices cause billions in losses for companies in the sector, with estimates indicating that they account for around 10% of all insurance claims – ultimately increasing costs for honest users. But how does this artificial intelligence model work in the field?
What are AI agents?
They are software programs that interact with their environment autonomously, collecting data and using it to perform self-determined tasks to achieve predefined goals. Generally, a user sets the objective, but the AI Agent decides how to accomplish it, selecting the best actions and automating various processes along the way. For a practical example: an AI Agent handling customer service for an insurance company could ask the claimant several questions when activated and, based on the answers, search the company’s database for information and formulate a response to the customer’s inquiry.
Designed for specific purposes and operating in specific data scenarios, AI Agents are capable of increasing productivity in companies. This happens, for example, through the automation of repetitive tasks, as AI Agents can automate daily activities such as data entry, report generation, meeting scheduling, and minute-taking, as well as analyzing and extracting key information from documents. This allows employees to focus on more strategic activities.
But how do AI Agents help insurance companies in fraud prevention? We’ll explain this now in six points:
1 – AI Agents perform predictive analysis and create more efficient risk scores
They use predictive models capable of analyzing and predicting potential fraud even before an insurance policy is approved. This analysis cross-references data to detect suspicious connections between different policyholders, brokers, and service providers. Additionally, it checks geolocation and banking data to identify inconsistencies. Finally, it automatically generates a risk score for each claim request.
2 – Detection of Suspicious Patterns
The use of AI Agents in insurance companies for fraud detection enables the analysis of large volumes of data in real time, allowing the identification of suspicious behaviors in just a few seconds. This is made possible through Machine Learning, which can detect fraud patterns in claims history. Machine Learning also automatically compares new claims with past fraud cases and continuously monitors similar requests.
3 – Identification of Fake Documents and Fraudulent Information
AI Agents bring technologies such as OCR and image recognition. This allows them to verify the authenticity of documents submitted by policyholders. With Machine Learning, they can analyze document histories to identify fraudulent patterns and perform automatic identity validation for online requests.
4 – AI Agents Use External Databases
They can integrate with public and private external databases to perform automatic checks and verify the history of potential clients. By doing so, they cross-reference information with data from regulatory agencies and other insurance companies. It is also possible to validate IDs, documents and judicial history to identify repeat fraud offenders.
5 – Behavioral Analysis in Customer Service Calls
The best AI Agents—like those from Pipefy—can analyze tone of voice and language in customer service calls. This allows them to identify contradictions in clients’ statements during claims processes. Additionally, they monitor interactions in chatbots and emails, detecting rehearsed or inconsistent responses in interviews with experts.
Read more
- How to choose an AI Agent for your company?
- AI Agents: boost productivity and reduce costs in your company
- Process automation with AI: optimize business operations
6 – Faster Investigation Processes
By automatically filtering suspicious claims, AI Agents reduce the workload of insurance companies’ anti-fraud teams. This is achieved through automation in evidence collection, which speeds up verification processes, as well as smarter case classification, enabling more detailed investigations. The result is a reduction in false positives, protecting legitimate customers.
If your company wants to enjoy all the benefits of process automation brought by AI Agents, book a free Pipefy demo and discover how this technology can transform your operations.
