Global Insurance Underwriter · Insurance
The underwriter's fraud analytics team focused their resources on high-value claims — those above $50,000 — which represented 12% of claim volume but a large share of visible fraud. The remaining 88% of lower-value claims were processed with minimal fraud scrutiny. Organized fraud rings had identified this threshold and were operating sophisticated schemes just below it, using large networks of claimants to aggregate significant losses from individually unremarkable claims.
Full claims event coverage with LLM reasoning applied to every claim regardless of value. The model identified network relationships between claimants, solicitors, medical providers, and adjusters — surfacing organized schemes that individual claim analysis could never detect.
"We had been looking at the top of the iceberg for years. The organized fraud was happening below our visibility threshold. Full coverage changed everything."
Global Head of Claims Fraud Intelligence
The largest scheme identified involved 312 connected claimants, 8 medical providers, and 3 legal firms operating a coordinated soft-tissue injury fabrication ring. Individual claims averaged $28,000 — below the manual review threshold. The network had submitted $68M in claims over 26 months. The LLM identified the network topology within 72 hours of full coverage.