Leveraging Data & AI for Abuse & Fraud Identification in OPD Health Insurance Claims

In this session, Nitin will delve into the evolving landscape of Outpatient Department (OPD) insurance in India, where rapid expansion has led to an increase in claims volume, particularly characterized by numerous low-value claims. These claims require swift adjudication, but they also pose a significant risk of abuse and fraud. Nitin will discuss typical patterns observed in these claims and how advanced AI/ML models are being leveraged to enhance fraud detection capabilities. This session aims to provide insights into cutting-edge techniques and strategies for mitigating fraud in healthcare insurance, contributing to the integrity and sustainability of insurance systems in India.