Insurance fraud detection rate soars 175% with real-time intelligence

Every insurance claim tells a story – and some deserve a closer look. For Gjensidige Baltics, which serves hundreds of thousands of customers across Lithuania, Latvia and Estonia, staying ahead of fraud means constantly adapting to new tactics and technologies. For years, the company relied on a straightforward set of about 20 rules built into its claims system, a practical approach that kept operations efficient.

But as fraud schemes grew more sophisticated, Claims Fraud Analyst Lina Ribokaitė and her team saw an opportunity to strengthen their defenses. “We wanted to move beyond basic, static rules and build a system we could strategically control,” Ribokaitė says. “Our goal was an adaptive platform that allows us to self-regulate scores and target fraud trends.” By layering advanced analytics and real-time scoring on top of existing rules, Gjensidige Baltics built a smarter, more adaptive way to spot suspicious activity as it occurs – delivering faster insights, stronger fraud prevention, and greater confidence across the business.

A partnership to fight insurance fraud

The team started by examining the rule-based system closely and identifying where it could be even more effective. While the simple rules had worked well to flag potential issues, they often triggered cases based on a single indicator, generating false positives and stretching investigator time. To address this, Gjensidige Baltics collaborated with local SAS partner and technology expert Paspara to implement a comprehensive SAS fraud solution that layered advanced analytics with real-time monitoring—continuously checking claims for fraud and giving the team the flexibility to adapt as new schemes emerged.

The collaboration brought together a suite of tools designed for both speed and depth, delivering instant fraud scoring while supporting detailed investigations. With SAS Intelligent Decisioning, the team could move beyond the old “one rule trigger” approach to a smarter, more dynamic evaluation of claims as they were processed. At the same time, SAS Visual Investigator provided analysts with a unified, intuitive workspace to quickly and efficiently review suspicious cases flagged by the advanced models.

Romualdas Saletis, Deputy Managing Director at Paspara, and his team worked closely with Gjensidige Baltics to carry out the project and help the insurer identify fraud pertaining to property damage to motor vehicles. The solution was deployed across the Baltics and included new online fraud detection rules and streamlined data integration processes.

“Paspara implemented the SAS fraud detection solution at Gjensidige Baltics through a structured approach, starting with requirement analysis, data integration design and system configuration,” Saletis says. “We collaborated closely with the business and IT teams to establish reliable data flows, validate results and ensure a smooth transition to production. The result was a fully operational fraud detection solution aligned with Gjensidige’s fraud detection strategy.”

“Now, Gjensidige Baltics can detect fraud online during the claims submission process and investigate suspicious cases offline with the help of SAS Fraud Decisioning for Claims,” Saletis continues.

The entire solution was deployed on Gjensidige Baltics’ on-premises servers to meet strict GDPR and data security requirements.

“Our core requirement was simple – advanced fraud detection must happen in real time,” Ribokaitė says. “The team recommended implementing SAS Intelligent Decisioning, which immediately gave us the capability to evaluate and score claim fraud as it happens.”

175% improved success rate and doubled savings

With the SAS solution in place, Gjensidige Baltics’ fraud detection capabilities quickly began to pay off. The ability to update rules and models internally allowed the team to adapt to unique regional fraud patterns, continually improving accuracy. Real-time scoring meant the system could automatically reassess each claim as new information was added, providing a layer of security that had previously been impossible.

Within three years, fraud detection accuracy skyrocketed by 175%.

“Back in 2021, our success rate for correct hits was 8%. By 2024, it had climbed to 22%, which is really great,” Ribokaitė says. “During the same three-year period, we doubled the amount saved by preventing fraudulent claims.”

Next steps: Further sophistication and SAS^® Viya^® 4

Gjensidige Baltics continues to partner with Paspara to refine and expand its fraud detection capabilities, introducing more targeted, data-driven rules to address emerging patterns. The team also plans to integrate new data sources, including health information, and migrate to the SAS Viya 4 platform to stay at the forefront of innovation.

“For us, this is about staying proactive,” Ribokaitė concludes. “Fraud never stands still, and neither do we.”