In-house claims fraud scoring (Zurich Switzerland and Zurich Brazil, ZCAM)
by Zurich Insurance Group (Zurich Switzerland, Zurich Brazil) · Primary insurer
Market unit: CH, BR
Zurich's in-house claims fraud-detection system was developed by ZCAM (Zurich Customer Active Management), its wholly owned data-analytics company with about 50 specialists. In Switzerland, most of the more than 600,000 claims received each year pass through a proprietary fraud-scoring tool fed by the Allegro claims system and receive a 0-100 risk score, with high scores prompting closer review by the Special Investigation Unit. Alongside the rule-based system, a machine-learning model has been piloted in German since February 2024 for property and commercial lines. Zurich Brazil adopted ZCAM's system in its affinity business (extended warranties, mobile-phone theft) and extended it to motor claims; the affinity fraud detection rate trebled (Zurich, September 2024).
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AI capability and maturity
AI capability level
Capability Maturity Score (CMS)
5 / 6
Business Adoption Score (BAS)
4 / 6
AI Development Index (ADI)
20 / 36
Business context
- Purpose of use
Score incoming claims for fraud risk and flag suspicious claims for investigators while reducing false positives.
- Value chain steps
- Claims managementFraud detection and prevention
- Insurance branches
- Property insuranceMotor vehicle insuranceSpecialty insurance
- Application scope
- Internal only
- Business criticality
- Mission critical
- Country or market unit
- CHBR
Value and impact
- Added value category
- Risk reductionEfficiency gain
- Estimated weekly case volume
- 11,538
- Quality gain
Fraud detection rate in Zurich Brazil affinity business trebled (Zurich, 2024)
Technical details
- AI category
- Machine learning and predictive analyticsNatural language processingAnomaly detection
- Model version
2024-08
- Technology stack
- PythonAzure Machine LearningComputer Vision API
- Interfaces used
Core claims platform via REST API
- Architectural insights
Hybrid architecture with a real-time scoring service and a batch retraining pipeline.
- Automation level
- 3/5
- Estimated IT difficulty
- 4/5
Compliance and governance
- EU AI Act risk category
- Not available
- EU AI Act role
- Not applicable
- Relevant policies
- Swiss Federal Act on Data ProtectionOther
- Responsibilities
Claims operations team retains final decision authority; model governance owned by the data science office.
- Data used
Historical claims records, repair cost databases, vehicle damage photographs.
Metadata
- Development type
- Scaled application
Publications over time
When this solution was reported on. Rumors are unverified mentions.
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