This initiative will support the launch of a new fraud-focused department in April 2025.
ClaimGuard’s deep customisation capabilities will play a pivotal role in Sompo Japan’s fraud prevention strategy, helping the new department develop effective investigation and response policies. The AI-driven system will manage fraudulent claims while ensuring the prompt payment of legitimate ones. As ClaimGuard continues to learn, it will proactively adapt to Sompo Japan’s specific policy types and fraud patterns, keeping the company ahead of emerging threats.
The AI model will be trained exclusively on Sompo Japan’s proprietary data, allowing it to address the insurer’s unique fraud risks. Leveraging rapid learning, contextual analysis, and adaptive technology, the system will enable fraud specialists to accurately identify existing fraud schemes and detect new patterns across the entire claims lifecycle.
Beyond fraud detection, ClaimGuard will assist in identifying high-risk cases earlier in the claims process, improving efficiency by expediting legitimate claims and payments. The system’s customisable fraud detection thresholds will enable proactive adjustments to evolving fraud tactics.
“Unlike other solutions on the market, we have designed ClaimGuard to be tailored to our client’s specific data and fraud profile,” said Mike Dwyer, Chief Technology Officer at EIS. “By centralising all relevant data, including external sources, Sompo Japan can create a comprehensive data warehouse that allows for in-depth investigations based on region, claim type, and risk. This capability not only benefits claims management but also supports other business departments.”
With this strategic deployment of ClaimGuard, Sompo Japan is set to strengthen its fraud detection and response capabilities, ensuring greater efficiency and security in its insurance operations.
