Organizations: Department of Mathematics and Computer Science, Sri Sathya Sai Institute of Higher Learning, Vidyagiri, Puttaparthi, Andhra Pradesh, India.
Fraud detection is an important area of research in the insurance business due to its financial implications. The primary aim of a fraud detection model is to identify fraud and non-fraud cases with high accuracy along with other important metrics such as Sensitivity, Specificity, Precision, F1-score, False Positive Rate, False Discovery Rate, AUC etc. To achieve this, we need to explore a suitable classification model to identify fraud and non-fraud cases. In this work, we have used auto insurance data set and explored classification models such as Decision Tree (DT), Random Forest (RF), XGBoost, LightGBM and Gradient Boosting Machine (GBM). To overcome the problem of data imbalance, we have employed MWMOTE and TGAN techniques. We have used Topological Node Feature(TNF) based spectral embedding for low dimensional data representation along with some popular embedding methods like MDS, Isomaps and t-SNE. After studying all the 65 possible combinations of these models, we have proposed an innovative method for effective automobile insurance fraud detection. For the given dataset, our results show that using a combination of MWMOTE as a data imbalance handling technique (Phase I), TNFSE2 as data embedding (Phase II) and Random Forest as classification (Phase III) provides the best result in comparison to all other combinations. This work also highlights the efficacy of TNF based spectral embedding in automobile insurance dataset
Insurance fraud imposes substantial financial losses and operational inefficiencies, raising premiums and impacting trust among legitimate policyholders. Early detection at FNOL remains a persistent challenge. Existing approaches rely largely on private, text-only datasets, limiting progress on multimodal methods that integrate linguistic, behavioural, and speaker-based indicators. We introduce a synthetic multimodal framework that replicates FNOL conditions. It generates agent-customer dialogue transcripts and two-speaker audios, performs ASR and diarisation. Downstream modules combine NER, regex-based feature extraction, LLM-RAG retrieval, and speaker embeddings in a rule-based risk score to flag narrative reuse, structural inconsistencies, and cross-case voice repetition while balancing sensitivity and false positives. Dataset validation and component-level evaluations show stability and transfer potential, offering a reproducible baseline beyond text-only fraud detection.
Muhammad Shakeel Akram, Amal Htait, Abdul Hamid Sadka +2
Aston University, Birmingham,UK. · Domestic & General, Wimbledon, UK.
Working entirely on topologically anonymized embeddings, we perform fraud detection using iterative rounds of unsupervised filtering followed by supervised sniping. The result is an ultra-low latency privacy--preserving triage that allows institutions to flag suspicious activity without compromising Personally Identifiable Information.
Money laundering through insurance claims poses a threat to insurers both through fraudulent payouts and reputational and regulatory risk. Despite this, little research has examined how such laundering can be prevented. This paper examines whether machine learning can help insurers flag suspicious claims before payout, shifting the focus from passive reporting to active prevention. Using production data from a major Norwegian insurer, we train gradient-boosted decision tree models to detect claims later reported to authorities for suspected money laundering. Because fraud and laundering may share behavioural patterns, we also examine whether insurance fraud labels can serve as an auxiliary training signal. We compare different learning setups using the Budget-Weighted Capture Rate, a metric introduced in this paper to measure how many laundering cases are captured when only a small share of claims can be manually reviewed. The results show that incorporating fraud-related investigation labels substantially improves laundering detection. The best-performing model captures nearly two-thirds of laundering cases within the top-ranked 2 to 6 percent of claims selected for investigation. To our knowledge, this is the first empirical study of machine learning for money laundering detection in insurance claims.
Dara Goldar, Geir Kjetil Ferkingstad Sandve, Martin Jullum
Fremtind Insurance · University of Oslo · Norwegian Computing Center