Insurance fraud costs $308B annually. Most of it is invisible to existing systems.
Point-in-time fraud scoring models evaluate claims individually. Fraud rings don't work individually — they operate across claimants, providers, and policies in coordinated patterns that only become visible through graph analysis. Prescott Data's Odin engine builds the graph that exposes them.
Every stage of the insurance operation, automated.
Claims Processing Automation
Automate intake, triage, coverage validation, and payment workflows. Reduce claims cycle time while producing fully auditable adjudication records for every decision.
Insurance Fraud Detection
Connect claimants, providers, and brokers across claims histories to expose coordinated fraud rings in real time — before payouts are processed.
Underwriting Intelligence
Surface correlated risk signals across applicant data, loss histories, and third-party datasets. Make underwriting decisions faster with a defensible evidence trail.
Subrogation & Recovery
Identify recovery opportunities across settled claims using graph intelligence. Automate the investigation and documentation workflow for pursuit decisions.
Regulatory Compliance Reporting
Generate audit-ready compliance reports automatically. Monitor claims handling against state and federal regulatory requirements with real-time flagging.
Customer Intelligence
Build a unified policyholder view across lines of business, claims, and interactions. Identify churn signals, cross-sell opportunities, and retention risk in one place.
Insurance Claims Fraud Detection
Insurance fraud rings coordinate across multiple claimants, providers, attorneys, and brokers over extended time periods to stay below individual detection thresholds. Odin's graph intelligence maps these relationships in real time — connecting shared phone numbers, addresses, vehicles, providers, and payment recipients across your entire claims history to surface coordinated networks before payouts are processed.
Claims Adjudication
Insurance claims adjudication requires processing unstructured documents — handwritten loss runs, police reports, repair estimates, medical records — and applying complex coverage rules and policy terms to reach determinations. Dromos automates this deterministically, extracting structured data from unstructured inputs and applying policy logic to produce auditable adjudication records that satisfy state insurance regulation requirements for claims handling documentation.
Underwriting Intelligence
Underwriting quality drives loss ratios. AI for underwriting surfaces correlated risk signals across applicant data, third-party datasets, historical loss experience, and external risk indicators that manual underwriters reviewing individual applications cannot see. Odin's entity resolution links the applicant to related entities — vehicles, properties, prior claims, associated individuals — giving underwriters a complete exposure picture before binding.
Frequently Asked Questions
How does AI improve insurance claims processing?
AI in insurance claims processing automates the adjudication workflow — intake validation, coverage checking, reserve setting, fraud screening, and payment authorisation. Prescott Data's Dromos platform enforces deterministic execution so every claims decision is reproducible and auditable, which is critical for regulatory examinations and dispute resolution.
How is AI used to detect insurance fraud?
AI detects insurance fraud by using graph intelligence to map relationships between claimants, providers, brokers, and billing entities across historical claims data. This network analysis surfaces coordinated fraud rings — staged accidents, phantom providers, and inflated claims — that per-claim scoring models cannot identify.
What is AI for underwriting in insurance?
AI for underwriting analyses applicant data, third-party signals, and historical loss data to surface correlated risk factors. It accelerates risk assessment, improves pricing accuracy, and generates a documented evidence trail that supports regulatory and actuarial review.
Can AI in insurance comply with state and federal insurance regulations?
Yes. Prescott Data's platform is built for regulated environments. Every AI-driven underwriting and claims decision generates a complete audit trail with the input data, decision logic, and output — meeting the documentation requirements of state insurance regulators and federal oversight bodies.
How does Prescott Data approach insurance fraud ring detection?
Odin builds a live knowledge graph of insureds, claimants, providers, and payment flows. Graph traversal algorithms identify clusters, shared agents, overlapping claim patterns, and repeated relationships that indicate coordinated fraud — exposing rings that appear unrelated at the individual claim level.