ClaimSight
See the fraud. Shield the claim.
Africa-first AI fraud detection for insurance companies. ClaimSight scores every claim in real time, surfaces cross-insurer fraud networks, and verifies claims via mobile channels your policyholders already use.
The Problem
The African Insurance Fraud Crisis
Insurance fraud across Africa is escalating at an unprecedented rate. Manual reviews can't keep pace with increasingly sophisticated schemes, costing the industry billions annually.
African insurance market today
Projected $160.9B by 2033
of claims are fraudulent
Varies by market and product line
annual fraud cost in SA alone
South African Insurance Association
YoY increase in fraud cases
Across key African markets
Core Capabilities
Everything You Need to Fight Fraud
Intelligent Fraud Detection Engine
7-stage scoring pipeline combining rule-based detection, ML models, and behavioral analysis to catch fraud that manual reviews miss.
Cross-Insurer Intelligence Network
Privacy-preserving shared intelligence that identifies serial fraudsters across multiple insurers without exposing sensitive policyholder data.
Mobile-First Claims Verification
GPS-stamped photo capture, WhatsApp chatbot for claim submissions, and USSD fallback for areas with limited connectivity.
Voice & Local Language Analytics
NLP models trained on Bemba, Nyanja, Zulu, Swahili, and Yoruba for sentiment analysis and inconsistency detection in claim narratives.
Predictive Underwriting Scoring
Risk-adjusted pricing recommendations at the point of underwriting, using historical claims data and external risk signals.
Investigation Workflow & Case Management
End-to-end case management with auto-assignment, SLA tracking, evidence chaining, and audit-ready documentation for regulatory compliance.
How It Works
7-Stage Scoring Pipeline
Every claim flows through our multi-layered scoring engine. Each stage adds signal, producing a composite fraud score in under 200 milliseconds.
Feature Extraction
Structured and unstructured claim data is parsed, normalized, and transformed into 200+ engineered features for downstream analysis.
Rule-Based Detection
Configurable business rules catch known fraud patterns: duplicate claims, threshold breaches, policy timing anomalies, and blacklist matches.
ML Scoring
Ensemble models (gradient boosting + neural networks) trained on African claims data produce calibrated fraud probability scores.
Behavioral Analysis
Claimant behavioral patterns are compared against historical baselines to detect anomalous filing patterns, velocity changes, and lifestyle inconsistencies.
Network Analysis
Graph-based analysis maps relationships between claimants, providers, witnesses, and repair shops to uncover organized fraud rings.
Score Aggregation
Weighted ensemble combines all stage outputs into a single composite score (0-100) with explainable contributing factors for every decision.
Action Routing
Claims are auto-triaged into approve, review, or investigate queues based on configurable thresholds, with instant notifications to assigned handlers.
Why ClaimSight
Built for Africa. Not adapted.
Unlike global fraud platforms retrofitted for emerging markets, ClaimSight was designed from day one for the African insurance landscape -- its unique regulatory frameworks, mobile-first populations, and cross-border fraud challenges.
Africa-First ML Models
Trained on African claims data, not retrofitted Western models. Higher accuracy on local fraud patterns and regional risk profiles.
Network Effect Moat
Cross-insurer intelligence gets smarter with every participant. More insurers = better fraud detection for everyone in the network.
Mobile-First Architecture
WhatsApp, USSD, and SMS-based claim submission and verification. Designed for how African policyholders actually interact.
Local Language NLP
Voice and text analysis in Bemba, Nyanja, Zulu, Swahili, and Yoruba -- languages that global platforms simply don't support.
AWS Cape Town Region
Data residency in AWS af-south-1 for regulatory compliance. Sub-50ms latency across Southern and East Africa.
Micro-Insurer Friendly Pricing
Pay-as-you-go options and tiered pricing that makes enterprise-grade fraud detection accessible to smaller insurers.
Pricing
Simple, Transparent Pricing
All plans include core fraud detection, API access, and dedicated onboarding. Scale as your book grows.
Starter
For small insurers and MGAs getting started with AI-powered fraud detection.
- Up to 5,000 claims/month
- Core fraud scoring engine
- Dashboard & reporting
- Email support
Professional
For mid-market insurers needing the full detection suite and network intelligence.
- Up to 25,000 claims/month
- Full 7-stage pipeline
- Cross-insurer network access
- Mobile verification channels
- Priority support + SLA
Enterprise
For large insurers and groups requiring custom models, dedicated infrastructure, and white-glove support.
- Unlimited claims
- Custom ML model training
- Dedicated infrastructure
- Local language NLP
- On-premise deployment option
- 24/7 dedicated support
All plans include a 30-day free trial. Pay-as-you-go pricing also available at $0.50/claim for low-volume use cases.
Roadmap
Where We're Headed
Alpha Launch
Core scoring engine, dashboard, and API with 3 pilot insurers in Zambia. Rule-based + ML scoring live.
Beta Release
Cross-insurer network, mobile verification, WhatsApp claims bot. Expand to 10+ insurers across Zambia and South Africa.
Production Release
Full 7-stage pipeline, local language NLP, investigation workflow. SOC 2 Type II certification complete.
Regional Expansion
Expand to Kenya, Nigeria, and Ghana. Launch predictive underwriting module and reinsurance integration.
Continental Scale
Pan-African coverage, health and life insurance verticals, embedded insurance APIs, and regulatory reporting automation.
Ready to Shield Your Claims?
Join the growing network of African insurers using ClaimSight to detect fraud in real time, reduce losses, and protect honest policyholders.