Case Study: Online Insurance Provider achieves 92% fraud detection and 1-hour claim fulfillment with Explorium

Improved Fraud Detection Rates Using Dynamic Models For Insurers

Online Insurance Provider, a fast-responding online insurer, faced a surge of sophisticated medical claims fraud that its rules-based detection system could not reliably catch without slowing claim approvals. They engaged Explorium to move from rigid rules to dynamic, data-enriched fraud models that could detect subtle abnormalities without adding user-facing bottlenecks.

Explorium implemented dynamic model enrichment by integrating external data sources — economic indicators, social media and biographical signals, internet behavior, and alternative risk/credit scores — into the insurer’s fraud models. As a result, the company cut average claim fulfillment to about 1 hour and improved fraud detection by nearly 11%, raising the overall detection rate to 92% of fraudulent claims under review, while boosting revenue, reducing churn, and lowering per-transaction fraud losses.