Thaisa Braguim | VP of Sales & Marketing, Ebix Latin America
In an industry that moves hundreds of billions of reais every year, insurance fraud represents not only financial losses but also a threat to market sustainability and policyholder trust. According to estimates from CNseg – the National Confederation of Insurers, around 10% of claims paid in Brazil may be linked to fraudulent activity — a figure that not only burdens the system but also distorts product pricing and negatively affects all stakeholders involved.
Given this scenario, the adoption of advanced monitoring and data analytics technologies is no longer a competitive advantage — it is a strategic necessity. Among these technologies, Artificial Intelligence (AI) stands out as one of the most effective tools to detect fraudulent attempts with agility and precision, acting preventively, in real time, and based on behavioral patterns that were once invisible to traditional methods.
The Evolution of Fraud Detection: From Reactive to Predictive Models
Historically, the fight against insurance fraud relied on reactive models: manual audits, rule-based analyses, and the investigation of inconsistencies only after claims were paid. This model, while common, is costly and often fails to identify more sophisticated or well-orchestrated fraud schemes.
Artificial Intelligence completely changes that dynamic.
Through machine learning algorithms, neural networks, and natural language processing (NLP), AI can cross-check thousands of variables in seconds, recognize anomalous patterns, and flag suspicious behavior even before policy settlement. This enables insurers and brokers to act proactively — minimizing risks and accelerating responses to critical situations.
How AI Detects Fraud in Real Time
AI-based solutions can be trained to identify subtle signs of inconsistency through a combination of complementary approaches:
- Behavioral pattern analysis: the system evaluates the policyholder’s history, movements, and policy characteristics to identify deviations from comparable profiles.
- Document and image recognition: using advanced OCR and computer vision, AI verifies documents, photos, and videos submitted in claims processes, detecting alterations, manipulations, or inconsistencies.
- Geolocation and device monitoring: sensors and mobility data help confirm whether the declared information matches the actual event (e.g., time and location of the claim).
- Integration with external public and private databases: cross-referencing with official sources such as Detran, Receita Federal, and Serasa helps validate registration data and detect deliberate fraud attempts.
- Detection of fraudulent networks: deep learning algorithms can identify recurring patterns across multiple claims that may seem legitimate individually but reveal suspicious connections when analyzed together.
With every new case, the system continuously learns and improves its predictive accuracy — turning data into a living, evolving intelligence.
Ebix’s Role in Transforming Fraud Prevention
As an insurtech specialized in digital solutions for the insurance industry, Ebix Latin America continuously invests in technologies that combine analytical intelligence, process automation, and multichannel integration. Its modular platforms are equipped with AI-driven analytics engines capable of processing large data volumes and identifying risk signals with a high degree of accuracy.
Among the key benefits for insurers and brokers are:
- A significant reduction in paid fraud rates.
- Faster, evidence-based decision-making.
- Enhanced governance and traceability across processes.
- Optimization of claims and compliance workflows.
- Increased trust among clients and partners.
Ebix also plays a strategic role in integrating AI-driven fraud detection tools with legacy systems, CRMs, and ERPs — enabling the technology to operate in full compliance and reliability across the entire insurance value chain, without requiring major infrastructure overhauls or process reconstruction.
AI as an Ally for Risk Management and Regulatory Compliance
Artificial Intelligence is also emerging as a powerful ally in risk management and regulatory compliance. The ability to audit data in real time, trigger automated alerts, and maintain full audit trails strengthens governance and significantly reduces operational risk — particularly in an increasingly demanding regulatory environment.
Events such as FENASAÚDE already show growing adoption of AI tools in health insurance, focusing on the verification of procedures, claims, and reimbursements. This evolution — which is expected to expand to other lines of business — represents a concrete opportunity for efficiency and transformation in the sector.
Conclusion: Innovation in the Service of Trust and Sustainability
Artificial Intelligence is not just an emerging technology — it is an indispensable ally in the mission to make the insurance market more transparent, reliable, and sustainable. By adopting AI-based solutions, insurers and brokers not only reduce financial losses but also strengthen their credibility and build lasting trust with their policyholders.
Ebix Latin America positions itself as a strategic partner in this transformation, offering solutions that combine innovation, technical robustness, and deep industry expertise. If your organization seeks to anticipate risks, protect its operations, and accelerate its digital maturity, speak with one of our specialists.
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About Ebix Latin America: The Leading Insurtech in the Insurance Market
👉 Learn more: Ebix Latin America
Ebix Latin America is a global insurtech specializing in the development of innovative technology solutions for insurers and brokers. As a trusted leader in insurance technology, we provide the industry’s most comprehensive suite of digital solutions, delivering efficiency, automation, and integration across the entire insurance value chain.
With around 400 employees and offices in São Paulo, Rio de Janeiro, and Curitiba, we serve the entire Latin American region and are the largest company in Brazil exclusively dedicated to insurance technology.
We turn challenges into innovation. Join us in this revolution in insurance technology.
