A leading health insurer was struggling to keep pace with evolving fraud risks in medical claims. Their framework relied on static, rule-based methods that could not adapt to new fraud tactics.
Complex claim data
Difficult to define abnormal claims due to multiple influencing factors.
Inconsistent labeling
Investigators flagged claims differently depending on medical knowledge and prescription variations.
Outdated detection logic
Static rules failed to catch sophisticated or emerging fraud schemes.
Frequent changes
Constant updates needed for new products and plan variations.
Resource strain
– Processing large datasets and redefining rules slowed investigations.
Negative impact
Delayed detection led to missed fraud, false positives, slower settlements, dissatisfied customers, and rising losses
The insurer deployed Marvel.ai, our AI-first, Cloud-native, and CX-centric Business Transformation Engine, to modernize fraud detection and reduce false positives.
in manual effort.
of fraudulent claims, preventing revenue leakage
improving accuracy and fairness
with consistent detection and audit trails
to handle rising claim volumes
through quicker, more accurate settlements
Join the companies that chose transformation over stagnation. Marvel.ai isn't just a platform—it's your revolution catalyst. The future of business transformation starts with a single decision.