Client overview
A Fortune 500, leading global risk management company, partnered with Zensar to modernize and scale its fraud detection capabilities for mobile claims processing. The initiative aimed to reduce manual effort, accelerate claim approvals, and enhance fraud prediction accuracy across geographies.
Challenges
Traditional rules-based systems used by the client's Global Risk Management (GRM) team flagged claims based on static combinations of signals, often leading to false positives and increased manual review time. The client sought a scalable, intelligent solution that could:
Accurately predict fraudulent claims using advanced analytics
Reduce time spent on assessing low-risk claims
Scale seamlessly across multiple geographies, including the US, UK, Canada, and Brazil
Solutions
We designed and implemented a Mobile Claims Fraud Risk AI/ML Scoring Solution that leverages cutting-edge data science and engineering practices.
Pilot AI model: Developed a Suspicious Activity Score model that assigns a probability score to each claim, enabling faster triage and prioritization.
Graph-based intelligence: Incorporated graph structures to model relationships and interactions in the data, uncovering complex fraud patterns that traditional models miss.
Robust ETL pipeline: Built a scalable pipeline to ingest, clean, transform, and store data from multiple sources, enabling:
Efficient model training
Variable change detection
Rescoring triggers
Scoring drift detection
MLOps integration: Implemented a full MLOps pipeline for seamless deployment, monitoring, and logging, ensuring the model remains performant and adaptable without constant manual retraining
Business impact
Faster claim approvals:
Reduced manual review time for low-risk claims, improving the customer experience.
Reduced false positives:
Enhanced fraud detection precision, minimizing the number of legitimate claims incorrectly flagged.
Scalable architecture:
Designed with global expansion in mind, the solution is now being scaled to support operations in the UK, Canada, and Brazil
Looking ahead
This initiative not only modernizes our client’s fraud detection capabilities, but also lays the groundwork for broader AI adoption across their claims ecosystem. With a scalable architecture and intelligent scoring at its core, the solution is poised to deliver long-term value across geographies and business lines.