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AI Tools for Insurance Fraud Analysts
AI tools that help insurance fraud analysts investigate suspicious claims, research claimant backgrounds, screen medical providers, and build evidence packages for referral to SIU.
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SourceFindingDate
FL SOSChen Home Services LLC — active business registration5 months post-claim
Instagram8 posts showing heavy lifting and physical workDuring disability period
Bexar County CourtsPrior bodily injury claim 2019 — same attorney2019
LinkedInProfile updated — seeking employmentDuring disability
SIU referral recommended · social media preserved with timestamps
Claimant background investigation
Thoroughly investigate a suspicious claimant: search public records, social media, business registrations, and news mentions to find evidence inconsistent with the claimed injury. Identify prior claims, criminal history, or activities that contradict the stated disability.
Run a full background investigation on claimant Robert Martinez, DOB 11/22/1975, San Antonio TX. He claims he cannot walk without assistance after a fall at work.
Found: Facebook account with recent posts — 3 photos hiking at Big Bend National Park, dated 6 weeks post-accident. LinkedIn shows active employment at a second job as a golf instructor. Prior bodily injury claim in 2018 (Bexar County court record). Recommend SIU referral with social media preservation.
ToolRouter search_person
SourceFindingDate
FacebookHiking photos — Big Bend National Park6 weeks post-accident
LinkedInActive employment: golf instructorDuring disability
Bexar CountyPrior BI claim 2018 — same plaintiff attorney2018
SIU referral recommended · social media preservation required immediately
ToolRouter search_content
6 weeks post-accident
Facebook: 3 hiking photos at Big Bend (2,000+ ft elevation)
8 weeks post-accident
LinkedIn: Golf instructor position updated as current employment
10 weeks post-accident
Facebook: Golf round photo with friends
Medical provider fraud screening
Screen medical providers, attorneys, and third-party vendors associated with suspicious claims. Check for OIG exclusions, state Medicaid exclusions, professional license sanctions, and prior fraud convictions. Identify provider mills and attorney referral networks operating in high-fraud markets.
Screen Advanced Pain Management Center LLC in Los Angeles and its owner Dr. Kevin Park against fraud databases. This clinic appears on 34 of our open PIP claims this month.
Dr. Kevin Park: no OIG exclusion. However, 2021 California Medical Board probationary order for inappropriate pain medication prescribing — still active. Clinic address matches a prior Medicare fraud scheme (2019 DOJ settlement, different entity, same address). Recommend SIU referral and network-wide flag.
ToolRouter screen_entity
DatabaseEntityResult
OIG LEIEDr. Kevin ParkClear
CA Medical BoardDr. Kevin ParkFlagged
DOJ recordsClinic addressFlagged
CA Medi-CalClinic entityClear
Medical Board probation active · prior fraud address match · SIU referral + network flag
ToolRouter research
Claims volume
Appears on 34 PIP claims this month — top 1% of LA providers
Medical board
Probationary order 2021 — inappropriate opioid prescribing
Address history
Same address as 2019 DOJ Medicare fraud settlement ($1.2M)
Pattern
High-volume PIP billing with same attorney on 28 of 34 claims
Corporate structure and address investigation
Investigate suspicious business entities in claims — staged accident rings, medical mills, or attorney-referral networks. Map the ownership structure, registered addresses, and common directors to identify coordinated fraud schemes.
Look up all companies registered to the address 8200 NW 27th Ave, Miami FL. I believe this is a hub for a staged auto accident ring.
Found 7 companies at this address: 3 medical clinics, 2 transportation companies, and 2 legal support firms. All formed within an 18-month window (2020–2021). Two share the same registered agent and one common director appears in 5 of 7 entities. Classic staged accident network structure.
ToolRouter lookup_company
EntityTypeFormed
NW Medical Associates LLCMedical clinic2020
Biscayne Transport Inc.Transportation2020
Dade Legal Support GroupLegal support2021
Miami Health Solutions LLCMedical clinic2021
7 entities · same address · 18-month formation window · common director in 5 of 7
Property claim fraud investigation
Investigate suspicious property claims — over-valuations, arson for profit, and contractor fraud. Research comparable property values, verify contractor licenses, and screen for prior claims at the same address or by the same insured.
A homeowner filed a $280,000 personal property loss claim after a house fire. The property is in Flint, Michigan. Research the property value and any prior claims at this address.
Zillow AVM: property valued at $64,000. Comparable sales in the same zip code average $58,000. A $280,000 contents claim on a $64K home is a significant over-valuation red flag. Prior insurance claim found at same address in 2019 (water damage). Recommend full SIU investigation.
ToolRouter search_listings
Data pointValueSource
AVM estimate$64,000Zillow AVM
Zip code comparable sales avg$58,000MLS recent sales
Contents claim filed$280,000Claim submission
Claim-to-value ratio4.4x property AVMCalculated
Significant over-valuation flag · prior 2019 water damage claim · full SIU investigation required
Social media evidence collection
Monitor social media platforms for claimants with active claims. Document posts, check-ins, and photos that contradict claimed injuries or disabilities. Find evidence of undisclosed employment, physical activities, or lifestyle inconsistencies before deposition or trial.
Search all major social media platforms for a claimant named Jessica Nguyen, Houston TX, who claims chronic pain and inability to perform daily activities since an auto accident 8 months ago.
Found active Instagram account (@jnguyen_fits). 23 posts since the accident date — gym workouts, running events, and beach volleyball photos. Most recent post: competing in a 5K race last weekend. Post archive preserved with timestamps. Strong impeachment evidence for deposition.
ToolRouter search_content
1 month post-accident
Instagram @jnguyen_fits: Gym workout video — squats and deadlifts
3 months post-accident
Instagram: Beach volleyball tournament photo
5 months post-accident
Instagram: Half-marathon finisher photo
7 months post-accident
Instagram: 5K race completion — most recent post
Industry fraud pattern research
Research the latest fraud schemes targeting your lines of business. Stay current on emerging fraud trends, organized rings, and new tactics so you can update claim scoring models and alert underwriters about high-risk geographies.
Research current workers compensation fraud schemes in California. What are the most common patterns and which industries are seeing the highest fraudulent claim rates?
Current CA workers comp fraud: 3 dominant patterns — (1) massage therapy clinic networks billing for services not rendered ($340M estimated annual cost), (2) labor contracting fraud through shell LLCs avoiding experience mods, (3) prescription drug diversion through complicit physicians. Construction and agriculture are the highest-fraud industries.
ToolRouter research
Top scheme #1
Massage therapy networks billing for non-rendered services — $340M annual cost
Top scheme #2
Labor contractor shell LLCs avoiding experience modification factors
Top scheme #3
Prescription drug diversion through complicit physicians in high-fraud clinics
Highest-risk industries
Construction (32% of fraud losses) and agriculture (18%)
Geographic hotspots
Los Angeles, Fresno, and San Bernardino counties have highest fraud rates
Ready-to-use prompts
Investigate a claimant
Run a complete background search on Thomas Williams, DOB 9/3/1968, Detroit MI. He is claiming a spinal injury preventing all work. Find any social media, business registrations, court records, or news mentions.
Screen a medical provider
Screen Miami Orthopedic & Spine Associates LLC and its owner Dr. Alex Kowalski against OIG exclusion list, state medical board sanctions, and any prior fraud convictions or civil settlements.
Research fraud patterns
What are the current PIP (personal injury protection) fraud schemes operating in South Florida? Include descriptions of staged accident rings, medical mill billing patterns, and attorney solicitation tactics.
Search social media
Search Instagram, Facebook, and TikTok for a claimant named Brandon Lee, approximately 30 years old, from Phoenix AZ, who claims to be permanently disabled from a construction fall.
Company address investigation
Look up all registered businesses at 1120 S Alvarado St, Los Angeles CA. I need to identify the corporate structure and common ownership of medical entities at this address.
Property value check
Get current market value and comparable sales data for a residential property in New Orleans at 4821 Magnolia Ave. The claimant filed a contents loss exceeding $200,000.
Find fraud news
Search for news reports and press releases in the last 6 months about workers compensation fraud arrests, DOJ insurance fraud prosecutions, and FBI insurance fraud takedowns.
Research contractor fraud
Research the public records and business history of Storm Damage Pros LLC in Fort Lauderdale FL. They appear on 14 of our hail damage claims this year as the remediation contractor.
Tools to power your best work
Search creators, tags & posts
Regulatory ActionsSEC, CFPB, FDIC & Federal Register
People SearchFind anyone across 500+ sites
Real Estate DataListings, valuations & market data
Company LookupCompany data for UK, US & EU
Compliance ScreeningAML, sanctions, PEP & due diligence investigations
NewsSearch and track news worldwide
165+ tools.
One conversation.
Everything insurance fraud analysts need from AI, connected to the assistant you already use. No extra apps, no switching tabs.
Full SIU referral investigation
Conduct a thorough pre-referral investigation: gather all available intelligence on the claimant, providers, and entities before escalating to SIU.
Medical mill identification
Identify and document a suspected medical mill or provider fraud network across multiple claims.
Property fraud rapid assessment
Quickly assess a suspicious property loss claim by cross-checking value, prior claims history, and property owner background.
Frequently Asked Questions
Is it legal to search social media in insurance fraud investigations?
Reviewing publicly visible social media posts is generally permissible. Never access private profiles, use deceptive identities, or send friend requests to represented claimants. Follow your company's SIU protocols and consult with legal counsel on jurisdiction-specific rules — several states have restrictions on how social media evidence is obtained and used.
What fraud databases does the compliance screening tool check?
Compliance Screening checks OFAC SDN, EU and UK consolidated sanctions lists, PEP databases, and financial watchlists. For OIG exclusions, medical board sanctions, and Medicaid exclusions, use Deep Research to access HHS OIG LEIE and state medical board databases directly.
Can these tools replace a licensed private investigator?
These tools handle open-source intelligence (OSINT) gathering: public records, social media, business registrations, and online databases. For surveillance, in-person investigation, or evidence that requires a licensed PI under state law, you still need qualified investigators. OSINT from these tools significantly pre-qualifies cases before deploying field resources.
How do I preserve social media evidence for litigation?
Save and timestamp screenshots of relevant posts immediately upon discovery. Use web archive tools to capture the full URL and metadata. Social media evidence can be deleted — preserve it as soon as you find it. Consult your legal team on proper chain-of-custody procedures for evidence you intend to use in court.
Can the people search tool find prior insurance claims?
People Search finds public records, business registrations, court filings, news, and social media. Prior insurance claims are not in public databases unless they resulted in litigation. For prior claims, use your industry database (ISO ClaimSearch or NICB databases) in addition to OSINT tools.
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Works in Chat, Cowork and Code