2026 年至 2032 年保险诈欺侦测市场（按线路类型、应用和地区划分）

2026-2032年保险诈欺侦测市场评估

保险诈欺案件的增加，包括产物保险、意外险、健康险、车险和其他险种的虚假索赔，是推动保险诈欺侦测市场发展的主要因素。随着犯罪分子的手段越来越精明，保险公司正在寻找尖端的方法来检测和预防诈骗活动。根据 Verified Market Research 分析师估计，2024 年保险诈欺检测市场的价值约为 46.4 亿美元，预计在预测期内将达到 235.7 亿美元。

虚假索赔对保险公司造成的财务损失日益增加，推动了保险诈欺侦测技术市场的发展，因此需要创新的检测策略。随着监管要求的不断提高以及消费者对公开性和效率的期望不断提高，保险公司正在投资巨量资料分析和人工智慧等创新技术，以改善诈欺检测技术。这些积极主动的策略不仅有助于降低风险和成本，还能提升保险业的信任度和诚信度。这将推动市场在2026年至2032年间以24.85%的复合年增长率成长。

保险诈欺侦测市场定义/概述

保险诈欺侦测是侦测和预防保险业诈欺活动的过程，例如虚假保险索赔、夸大损失、製造事故以及在签发保单时提供虚假资讯。人工智慧、机器学习和预测分析等先进技术使保险公司能够快速且准确地分析大量数据，帮助他们即时发现可能预示诈欺活动的趋势和异常。透过有效的诈欺侦测系统，保险公司可以大幅减少财务损失，提高索赔处理效率，并维护客户信心。

推动保险诈欺侦测市场成长的关键因素有哪些？

保险诈欺事件的不断增加是诈骗侦测市场发展的主要驱动力。根据「制止保险诈欺联盟」统计，光是在美国，保险诈欺每年造成的损失就超过3,086亿美元。美国联邦调查局（FBI）估计，保险诈欺（非健康保险）每年造成的总损失超过400亿美元，导緻美国家庭平均多支付400至700美元的保险费。这种日益增长的威胁促使保险公司投资于先进的诈骗侦测系统。

在诈欺侦测系统中利用人工智慧和机器学习，可以提高其识别复杂诈欺趋势的能力。根据 Gartner 预测，到 2025 年，75% 的企业应用程式将整合人工智慧和机器学习技术，用于诈欺侦测和其他安全用例。随着企业寻求更有效率、更准确的解决方案，此类技术创新正在推动保险诈欺侦测市场的发展。

此外，监管审查和合规要求的不断加强，也促使保险公司建立有效的诈欺侦测系统。根据美国全国保险监督官协会 (NAIC) 统计，美国 48 个州、哥伦比亚特区美国维京群岛已根据 NAIC 的《保险诈欺预防示范法》通过立法，要求保险公司实施诈骗预防计画。反诈欺法律的不断涌现，也推动了保险业对先进诈欺侦测技术的需求。

推动保险诈欺侦测市场需求的挑战有哪些？

过时的内部诈欺检测系统是保险诈欺检测市场的重大瓶颈。许多保险公司仍依赖过时的系统和手动流程，导致诈欺侦测效率低且容易出错。这些过时的系统缺乏即时资料处理所需的互联互通，无法快速侦测复杂的诈骗方案。因此，依赖这些技术会降低诈欺侦测工作的整体有效性，并增加财务损失的风险。

此外，资料隐私问题也是保险诈欺侦测市场发展的一大障碍。随着敏感个人资讯处理的日益增多，保险公司必须遵守严格的资料保护和隐私要求。遵守这些法规会阻碍现代诈欺侦测技术的使用，因为保险公司必须准确识别诈欺性索赔，同时确保其係统不会违反个人资讯保护法。这种权衡之策限制了市场的成长潜力，并减缓了新解决方案的采用。

目录

第一章 引言

• 市场定义
• 市场区隔
• 调查方法

第二章执行摘要

• 主要发现
• 市场概览
• 市集亮点

第三章市场概述

• 市场规模和成长潜力
• 市场趋势
• 市场驱动因素
• 市场限制
• 市场机会
• 波特五力分析

第四章保险诈欺侦测市场（依保险类型）

• 健康保险
• 产物保险
• 人寿保险

第五章保险诈欺侦测市场（按应用）

• 保险诈骗
• 身分盗窃
• 支付和帐单诈骗
• 洗钱
• 其他的

第六章区域分析

• 北美洲
• 美国
• 加拿大
• 墨西哥
• 欧洲
• 英国
• 德国
• 法国
• 义大利
• 亚太地区
• 中国
• 日本
• 印度
• 澳洲
• 拉丁美洲
• 巴西
• 阿根廷
• 智利
• 中东和非洲
• 南非
• 沙乌地阿拉伯
• 阿拉伯聯合大公国

第七章市场动态

• 市场驱动因素
• 市场限制
• 市场机会
• COVID-19 市场影响

第八章 竞争态势

• 主要企业
• 市场占有率分析

第九章 公司简介

• SAS Institute
• IBM Corporation
• FICO（Fair Isaac Corporation）
• BAE Systems
• LexisNexis Risk Solutions
• ACI Worldwide
• Fiserv, Inc.
• SAP SE
• Experian plc
• RSA Security LLC
• Verisk Analytics, Inc.
• Shift Technology

第十章 市场展望与机会

• 新兴技术
• 未来市场趋势
• 投资机会

第十一章 附录

• 简称列表
• 来源和参考文献

Insurance Fraud Detection Market Valuation - 2026-2032

The growing number of insurance fraud cases, including fictitious claims for property, health, auto, and other insurance kinds, is the main factor propelling the insurance fraud detection market. As criminals become savvier, insurance companies are looking for cutting-edge ways to detect and prevent fraudulent activity. According to the analyst from Verified Market Research, the insurance fraud detection market is estimated to reach a valuation of USD 23.57 Billion over the forecast subjugating around USD 4.64 Billion valued in 2024.

Increased financial losses to insurers from false claims are driving the market for insurance fraud detection technologies. This has led to a greater need for creative detection strategies. As regulatory demands mount and consumer expectations for openness and efficiency rise, insurance companies are investing in innovative technologies like big data analytics and artificial intelligence to improve their fraud detection skills. This proactive strategy not only helps to mitigate risks and save costs, but it also promotes confidence and integrity in the insurance industry. It enables the market to grow at a CAGR of 24.85% from 2026 to 2032.

Insurance Fraud Detection Market: Definition/ Overview

Insurance fraud detection is the process of detecting and preventing fraudulent activity in the insurance sector, such as false claims, exaggerated losses, staged accidents, and misrepresentation of information during policy issuance. It entails the use of advanced technologies such as artificial intelligence, machine learning, and predictive analytics to rapidly and correctly analyze massive volumes of data, allowing insurers to detect trends and anomalies suggestive of fraudulent conduct in real time. Insurance businesses that deploy effective fraud detection systems can dramatically minimize financial losses, enhance claim processing efficiency, and maintain client trust.

What are the Key Factors Driving the Growth of the Insurance Fraud Detection Market?

The increased incidence of insurance fraud is a major driver of the fraud detection market. According to the Coalition Against Insurance Fraud, insurance fraud costs more than $308.6 billion a year in the United States alone. The FBI believes that the entire cost of insurance fraud (non-health insurance) is more than USD 40 Billion each year, costing the average American household between $400 and $700 in higher premiums. This increased threat is prompting insurers to invest in advanced fraud detection systems.

The use of AI and machine learning in fraud detection systems improves the ability to recognize complicated fraud trends. According to Gartner, by 2025, 75% of enterprise apps will integrate AI and machine learning technology for fraud detection and other security use cases. This technological innovation is propelling the insurance fraud detection market forward as businesses seek more efficient and accurate solutions.

Furthermore, the increasing regulatory scrutiny and compliance requirements are prompting insurance businesses to build effective fraud detection systems. The National Association of Insurance Commissioners (NAIC) says that 48 states, the District of Columbia, and the United States Virgin Islands have passed legislation based on the NAIC Insurance Fraud Prevention Model Act, which mandates insurers to implement anti-fraud programs. The widespread adoption of anti-fraud laws is driving up demand for advanced fraud detection technologies in the insurance business.

What are the Challenges Influencing the Demand for Insurance Fraud Detection Market?

Outdated internal fraud detection systems are a key impediment in the insurance fraud detection market. Many insurance businesses continue to rely on antiquated systems and manual processes, resulting in inefficiencies and mistakes in detecting fraudulent activities. These antiquated systems lack the interconnectivity required for real-time data processing, making it impossible to detect sophisticated fraud schemes quickly. As a result, dependence on these methods reduces the overall effectiveness of fraud detection efforts and raises the danger of financial losses.

Furthermore, data privacy concerns are another major impediment to the insurance fraud detection market. With the increased processing of sensitive personal information, insurance businesses must adhere to severe data protection and privacy requirements. Compliance with these restrictions hampers the use of modern fraud detection technology, as insurers must verify that their systems do not breach privacy laws while accurately identifying fraudulent claims. This balancing act slows the adoption of novel solutions while limiting the market's growth potential.

Category-Wise Acumens

How Does the High Incidence of Fraudulent Claims Drive the Detection of Health Insurance?

According to VMR analysis, the health insurance segment is estimated to dominate the market during the forecast period. The high rate of false claims linked with health insurance is one of the factors driving this dominance. Given the complexities of medical billing and the possibility of overstated claims, health insurers face considerable problems in detecting fraud. This has boosted the demand for sophisticated fraud detection technologies capable of analyzing medical records and billing data to find anomalies and prevent losses.

Governments and regulatory agencies are enforcing stronger requirements to combat healthcare fraud, requiring insurers to use advanced fraud detection systems. Compliance with these requirements not only helps to mitigate risks but also improves health insurers' overall operational efficiency, which drives up demand for fraud detection systems.

Furthermore, the growing usage of technology in the healthcare business is critical to the expansion of the health insurance fraud detection market. The combination of artificial intelligence, machine learning, and big data analytics allows insurers to process large volumes of data quickly and reliably. This technical development enables real-time monitoring and analysis, considerably increasing the ability to detect and prevent fraudulent activity in health insurance claims.

How does Claims Fraud Account Significant Part of the Insurance Fraud Detection Market?

The claims fraud segment is estimated to dominate the insurance fraud detection market during the forecast period. The rise in the number of false claims is a major reason for the claims fraud segment's growth. As insurance fraud becomes increasingly complex, insurers are under increasing pressure to improve their detection skills. This urgency drives increased investment in new technologies and analytics for detecting and mitigating fraudulent claims, guaranteeing financial stability, and protecting honest policyholders.

Technological improvements in data analytics and machine learning have considerably boosted the claims fraud segment. These technologies allow insurers to swiftly evaluate massive volumes of data, detecting trends and abnormalities that suggest probable fraud. As insurers employ more sophisticated detection systems, their capacity to quickly handle and evaluate claims improves, cementing the claims fraud segment's market leadership.

Furthermore, regulatory concerns and the requirement for compliance contribute to the claims fraud segment's prevalence. To comply with regulatory requirements and avoid penalties, insurers must increasingly demonstrate sophisticated fraud detection measures. This legal climate forces businesses to prioritize claims fraud detection, resulting in increasing investments in solutions that can successfully identify and resolve false claims, strengthening the segment's market position.

Country/Region-wise Acumens

How Does the High Incidence of Insurance Fraud Cases in North America Influence the Market?

According to VMR analyst, North America is estimated to dominate the insurance fraud detection market during the forecast period. North America, particularly the United States, experiences a high rate of insurance fraud, necessitating the development of improved detection technologies. According to the Coalition Against Insurance Fraud, insurance fraud costs Americans at least USD 308.6 Billion every year. The National Insurance Crime Bureau (NICB) finds that suspicious claims grew by 26.7% between 2017 and 2019. Due to the high occurrence of fraud incidents, regional insurance companies are investing extensively in fraud detection systems.

Furthermore, the regulatory landscape in North America, particularly in the United States, is requiring insurance companies to build robust fraud detection systems. According to the National Association of Insurance Commissioners (NAIC), 48 states in the United States have passed anti-fraud legislation based on the NAIC's model fraud statute. Also, the Insurance Information Institute notes that 42 states, including the District of Columbia, have established fraud bureaus to detect and prosecute insurance fraud. This regulatory pressure is a major driving force behind the deployment of advanced fraud detection technology in the North American market.

What are the Main Drivers of the Market in the Asia Pacific Region?

The Asia Pacific region is estimated to exhibit the highest growth within the insurance fraud detection market during the forecast period. The Asia Pacific region's insurance business is rapidly expanding, increasing the demand for fraud detection technologies. According to a Swiss Re Institute analysis, rising Asian insurance markets are predicted to increase by 8.5% by 2024, exceeding the global average. China, the region's largest market, saw insurance premiums rise by 4.7% in 2021, totaling USD 700 billion. The fast expansion of the insurance sector increases the risk of fraud, generating the need for improved detection technologies.

Furthermore, the expansion of digital insurance platforms in the Asia Pacific opens up new opportunities for fraud, needing more advanced detection systems. According to a Bain & Company analysis, digital insurance penetration in Southeast Asia is expected to increase to 11% by 2025, from 1.5% in 2019. According to the China Banking and Insurance Regulatory Commission, internet insurance premiums increased by 13.9% year on year in 2020, reaching RMB 298 billion (about USD 46 billion). This digital shift is driving insurers to invest in AI-powered fraud detection systems to address increasing cyber fraud threats.

Competitive Landscape

The competitive landscape of the insurance fraud detection market is characterized by a dynamic interplay between established players and rising startups, both of which strive to innovate and improve fraud detection skills. Companies are rapidly using modern technologies like artificial intelligence, machine learning, and big data analytics to improve their fraud detection systems, resulting in more effective identification and prevention of fraudulent activity.

Some of the prominent players operating in the insurance fraud detection market include:

SAS Institute

IBM Corporation

FICO

BAE Systems

LexisNexis Risk Solutions

ACI Worldwide

Fiserv, Inc.

SAP SE

Experian plc

RSA Security LLC

Verisk Analytics, Inc.

Shift Technology

Insurance Fraud Detection Latest Developments:

In May 2023, Verisk, a provider of insurance data analytics, partnered with CCC Intelligent Solutions, a cloud platform serving the property and casualty (P&C) insurance market. This collaboration aims to enhance insurance fraud risk management by integrating Verisk's claims fraud detection analytics with CCC's claims platform.

In March 2023, Shift Technology, a global provider of AI-driven decision automation solutions for insurers, expanded its partnership with the General Insurance Association of Singapore (GIA). This expansion involves extending the use of Shift Claims Fraud Detection to include travel insurance fraud detection. The initiative builds upon the success of GIA's Fraud Management System (FMS) and aims to enhance fraud detection capabilities across the sector. This collaboration enables GIA member insurers to effectively detect and manage fraudulent claims, particularly within the growing global travel insurance segment.

Insurance Fraud Detection Market, By Category

• Insurance Type:
• Health
• Property & Casualty
• Life Insurance
• Application:
• Claims Fraud
• Identity Theft
• Payment and Billing Fraud
• Money Laundering
• Others
• Region:
• North America
• Europe
• Asia-Pacific
• South America
• Middle East & Africa

TABLE OF CONTENTS

1. INTRODUCTION

• Market Definition
• Market Segmentation
• Research Methodology

2. Executive Summary

• Key Findings
• Market Overview
• Market Highlights

3. Market Overview

• Market Size and Growth Potential
• Market Trends
• Market Drivers
• Market Restraints
• Market Opportunities
• Porter's Five Forces Analysis

4. Insurance Fraud Detection Market, By Insurance Type

• Health
• Property and Casualty
• Life Insurance

5. Insurance Fraud Detection Market, By Application:

• Claims Fraud
• Identity Theft
• Payment and Billing Fraud
• Money Laundering
• Others

6. Regional Analysis

• North America
• United States
• Canada
• Mexico
• Europe
• United Kingdom
• Germany
• France
• Italy
• Asia-Pacific
• China
• Japan
• India
• Australia
• Latin America
• Brazil
• Argentina
• Chile
• Middle East and Africa
• South Africa
• Saudi Arabia
• UAE

7. Market Dynamics

• Market Drivers
• Market Restraints
• Market Opportunities
• Impact of COVID-19 on the Market

8. Competitive Landscape

• Key Players
• Market Share Analysis

9. Company Profiles

• SAS Institute
• IBM Corporation
• FICO (Fair Isaac Corporation)
• BAE Systems
• LexisNexis Risk Solutions
• ACI Worldwide
• Fiserv, Inc.
• SAP SE
• Experian plc
• RSA Security LLC
• Verisk Analytics, Inc.
• Shift Technology

10. Market Outlook and Opportunities

• Emerging Technologies
• Future Market Trends
• Investment Opportunities

11. Appendix

• List of Abbreviations
• Sources and References