With fraud costing insurers more than $308 billion annually, according to the Coalition Against Insurance Fraud, there is an urgent need for updated strategies.

Inaction carries significant consequences, including:

• Increased financial losses due to undetected fraud
• Longer delays and more disputes involving legitimate claims
• Reduced customer confidence in claims processes

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This article explores pressing new risks in claims and fraud, discusses how leading insurers apply AI to address these threats, and provides practical, expert advice for claims strategists.

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New fraud risks require advanced AI solutions

Today’s insurers face threats such as realistic deepfake videos and automated fraudulent claims. Advanced AI tools provide insurers with effective means to detect and prevent fraud.

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Detecting deepfake insurance fraud with AI

Imagine an insurance claim that appears flawless: compelling video evidence, credible documentation, and a trustworthy policyholder. However, deeper forensic analysis reveals the video evidence is an AI-generated deepfake.
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According to McKinsey, deepfake scams significantly contribute to the annual 10% rise in insurance fraud.

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Expert-developed forensic systems powered by AI have become essential, allowing insurers to detect manipulated media accurately and prevent fraudulent claims.

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AI in action: LexisNexis Risk Solutions

LexisNexis Risk Solutions effectively combines extensive data resources with sophisticated AI analytics, significantly improving fraud detection accuracy. Their platform analyzes vast data sets in real-time, promptly identifying suspicious activities. Insurers using these analytics experience fewer false positives and more efficient processing of legitimate claims.

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Countering AI-driven automated fraud

Insurers are not the only ones adopting AI—fraudsters increasingly use automated systems to submit convincing fraudulent claims. The National Insurance Crime Bureau found AI-enhanced fraudulent claims had a 22% higher success rate than traditional fraud methods.
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Insurers are responding by deploying adaptive AI detection models that continually learn and improve their capabilities based on emerging fraud patterns.

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Handling fraud during major events

Major catastrophes, such as Hurricane Ian, which caused over $50 billion in insured losses, often overwhelm claims departments, providing fraudsters with opportunities to file exaggerated or completely fabricated claims.
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AI-driven claims prioritization systems help insurers efficiently distinguish legitimate claims from fraudulent ones, allocating resources effectively during these critical periods.

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Leveraging regulation for stronger fraud intelligence

Recent regulations, including the EU’s AI Act and the U.S. Fraud Prevention Act of 2025, impose rigorous transparency, accountability, and data protection requirements. Claims strategists can turn these regulatory standards into opportunities by adopting clear, explainable AI-based fraud detection systems, thereby boosting insurer credibility and customer trust.

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Practical strategies for claims strategists

Claims strategists must stay ahead by adopting intelligent technologies and integrated approaches. Recommended strategies include:

• Modernize identity verification systems: Traditional verification methods struggle against sophisticated synthetic identities. Invest in biometric and AI-driven technologies.
• Use adaptive fraud detection models: Regularly train and update AI models based on new fraud trends and data.
• Integrate fraud intelligence company-wide: Eliminate data silos, ensuring AI insights guide decisions across departments.
• Prioritize transparency for compliance: Choose AI tools that provide clear explanations and satisfy regulatory demands, reinforcing policyholder trust.

From reactive measures to proactive intelligence

Fraud management is shifting from reactive defenses to proactive, intelligence-led approaches. AI allows insurers not just to accelerate claims processes but also anticipate threats and act before risks escalate. Claims strategists who recognize early signals can manage risks more effectively, turning potential threats into manageable scenarios.

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Want to stay ahead of emerging fraud risks? Trendtracker provides claims strategists with early warnings, allowing them to identify and act on fraud patterns before they cause substantial losses.

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