Humans and AI Fight Fraud Together - Podcast

Originally published by Insurance Journal on September 29, 2025.

Insurance Journal's podcast features Ashley Fong, VP at Carpe Data, exploring the evolving landscape of claims fraud detection. The conversation examines how artificial intelligence can process vast datasets to identify fraud patterns while human judgment remains essential for final decision-making.

Carpe Data research reveals that injury fraud concentrates in regions with strong legal networks, high population density, heavy tourism, economic hardship, and legal loopholes. The company's findings also show younger adults commit fraud more frequently, likely driven by riskier behaviors and cultural pressure to overshare on social media platforms.

Fong emphasizes the magnitude of the problem: in 2023 alone, fraudulent claims cost an estimated $300 billion, equivalent to 10 Hurricane Helene disasters. She notes that traditionally, carriers reviewed only 4 percent of open claims through manual, rules-based processes that were both tedious and expensive. With AI and human intervention working together, insurers can now generate 10 times more reviews.

The podcast underscores that while technology advances are essential, human roles will evolve toward areas requiring greater brainpower, judgment, and creativity. These are capabilities that computers cannot replicate, ensuring that fraud detection remains a collaborative effort between artificial and human intelligence.

Read the full article at Insurance Journal.