Claims Management: Detect and Prevent Fraudulent Claims Before Claims Are Paid - Curacel

Claims Management: Detect and Prevent Fraudulent Claims Before Claims Are Paid

September 1, 2021
Author: samson

The Problem: Insurance Fraud

Insurance Fraud is affecting the profitability of every insurance company. Referencing data; claims fraud is a global challenge. It’s estimated that annual fraud losses for the property and casualty industry are up to $40 billion in the US alone.

And it is happening fast.

Every year, African insurers lose more than $12 billion to fraudulent, wasteful, and abusive claims. Curacel’s flagship CLAIMS platform acts as a bridge between primary care hospitals and Africa’s insurance companies, using advanced artificial intelligence to ensure that insurance companies only pay claims for the correct treatment, appropriate medications and recommended patient therapies. AI and its related technologies will profoundly impact all aspects of the insurance industry, from distribution to underwriting and pricing to claims.

In 2010, It is estimated that “180 billion euros ($260bn) is lost globally every year to fraud and error in healthcare; 5.59% of annual global health spending is lost to mistakes or corruption” in an article by Reuters – a study by EHFCN.

To help understand the advancing significance of frauds within the insurance industry, we wrote an insight based on in-house and publicly available data. 

INSURANCE FRAUD

Per a Deloitte 2019 Insurance Outlook Report; “Tackling insurance fraud remains a priority for insurers. It is estimated that 25% of the insurance industry income in Kenya is fraudulently claimed. It is of key concern that insurers come up with ways of early detection and prevention of fraud in order to prevent the large amounts of losses.”That’s cash taken off a company’s bottom line.

Image: Photo by Jefferson Santos on Unsplash