Fraud detection
Insurance Claims Adjuster · Auto / Health Claims
“Fraud detection” (Insurance Claims Adjuster) is being replaced by AI: it entered in 2020 and is projected to be largely replaced by 2027.
What this task is
Adjusters look for signs of fraud in claims, such as repeat filings, staged accidents, inflated losses or collusion between repair shops and claimants, and decide whether to refer a case for investigation.
How AI replaces it
Since 2020, insurers have used risk-scoring models and link analysis across past claims, people and vehicles to flag suspicious cases automatically. By around 2027, initial screening and scoring are expected to be handled almost entirely by models.
What stays human
Investigators follow up on cases the models flag with field checks, interviews and evidence gathering, and they make the final call on whether fraud is established and what action to take.