Journal of Digital Engineering and Business Management

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Detection And Investigation Of Suspicious Insurance Claims Using Data-Driven Approaches

Authors: Dr. Peddi Kishor, Dr. Ch. Sampath Reddy

Abstract

The deliberate commission of an illegal act in order to profit is known as insurance fraud. This is currently causing problems for many insurance companies all over the globe. In most cases, the main problem is that there is a defect in the evaluation of false accusations. Therefore, measures to prevent fraud using computers had to be implemented. In addition to providing a risk-free setting for customers, this significantly reduced the number of fraud claims. To prove our point, we used Data Analytics and Machine Learning to automatically detect fraudulent claims and automated the process of examining insurance claims using several data methodologies. Heuristics for fraud indications may also be generated by the system. All throughout the insurance industry, this tactic boosts consumer satisfaction and company reputation.

Keywords

MachineLearning,DataAnalytics,FraudDetection,InsuranceCompany’sReputation, CustomerSatisfaction.

Article Information

Volume: 2
Issue: 1
Published Date: 22/01/2026
DOI: https://doi.org/10.5281/zenodo.19091664
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