When AI Acts Alone: The New AI Fraud Challenge Facing Insurers

Agentic AI Is Changing the Economics of Insurance Fraud

For insurance fraud and identity leaders, agentic AI represents a significant evolution beyond deepfakes. While deepfakes can generate convincing synthetic content, agentic AI can plan, act, adapt and coordinate complex, multi-step activities with limited human involvement. As a result, fraud schemes can become faster, more persuasive and easier to scale.

As fraud becomes more automated and orchestrated, insurers face growing pressure to continuously validate identity, assess risk and establish trust throughout the customer lifecycle.

What Is Agentic AI?

Agentic AI enables multiple AI systems to collaborate and execute tasks with limited human direction. In the insurance workflow, these systems can support legitimate functions such as claims intake and customer service. However, the same technology can also be used against carriers.

For example, one AI agent could submit a fraudulent claim, another could establish or manage accounts used to support the scheme, while a third monitors communications and automatically responds to requests for additional information. In workforce and vendor fraud scenarios, AI agents could create convincing applicant profiles, fabricate employment histories, generate synthetic references and maintain ongoing communications that make a fraudulent employee, contractor or vendor appear legitimate.

The fundamental shift is that fraud is moving beyond isolated acts of deception to automated end-to-end execution. What once required significant time and human coordination can now be orchestrated at scale with speed, consistency and minimal oversight.

Three Ways Agentic AI Is Accelerating Fraud

Speed

Agentic AI fraud systems can rapidly and independently generate claim narratives, invoices, receipts, repair estimates and other supporting materials without any human check-in.

Believability

Agentic AI can coordinate evidence, communications and next steps across a workflow, adjusting responses so each interaction appears consistent and credible.

Scale

Fraudsters can launch more fraud attempts across products, channels and geographies while continuously learning which controls may be easier to bypass.

The risk is not limited to claims submission. AI-enabled fraud can emerge at quote and bind, during policy servicing, at claims intake and at payment. Agentic AI can understand the steps, create a false story and generate credible artifacts at record speed, allowing fraud to operate at a much larger scale.

A More Connected Approach to Fraud Prevention

The answer is not to add friction to every customer interaction. It is to apply the right intelligence where risk is highest.

LexisNexis® Risk Solutions helps insurers develop a more adaptive and connected approach to fraud prevention by bringing together identity, device, behavioral, network and risk signals across the insurance lifecycle.

This approach can help carriers:

• Strengthen identity verification from quote through claim and payment.
• Connect intelligence across underwriting, claims, special investigations, digital and payment workflows to uncover risk patterns that may be difficult to recognize in siloed processes.
• Evaluate digital evidence in context using identity, device, behavioral and network signals.
• Adapt detection strategies as AI-enabled fraud tactics continue to evolve.

Looking Ahead

Agentic AI is increasing the speed, believability and scale of insurance and workforce fraud, amplifying the risks of credential misuse, data breaches and identity-based attacks. Yet it also creates an opportunity for insurers to rethink traditional fraud strategies and build trust throughout the customer journey.

The insurers best positioned for success will be those that can connect intelligence across workflows, assess risk with greater precision and adapt as threats evolve.

Fraudsters may be moving faster, but with the right intelligence, carriers can respond smarter. Watch our IDVerse webinar on demand to learn more.