Chapter 14 Application of Machine Learning for Fraud Detection – A Decision Support System in the Insurance Sector

Introduction: The insurance sector is playing a crucial role in the sustainable growth of the Indian economy. But in India, this sector loses crores of rupees every year due to the increasing fraud cases. With the increase in insurance customers, insurance companies need to efficiently equip themselves with a robust system to handle claims fraud. Detection of insurance fraud is a pretty challenging problem. Nowadays, machine learning (ML) and artificial intelligence (AI) are the strategic choices of many leading organisations that want to proceed in a new digital arena. Purpose: This chapter’s main objective is to highlight the fundamental market forces driving the adoption of AI and ML and showcase the traditional and modern methods to predict insurance claims fraud intelligently. Methodology: Various research papers have been reviewed, and ML methods have been discussed, which are all being used to predict insurance fraud claims. This chapter also highlights various driving forces influencing the adoption of ML. Findings: This study highlights the introduction of blockchain technology in fraud detection and in combatting insurance fraud. Literature indicates that the quantity and quality of data significantly impact predictive accuracy. ML models are beneficial to identify the majority of fraudulent cases with reasonable precision. Insurance companies should explore the benefits of experienced resource persons from the same domain and develop unique business ideas/rules.