Fraud & financial-crime controls
A meaningful share of insurance fraud and financial-crime exposure runs through parties, not just claims patterns: a blocked beneficiary, an undisclosed UBO, a counterparty that should never have cleared underwriting. InsureGuardAI is scoped to exactly that layer — sanctions and PEP screening on every party in a case, plus bordereaux intake with a retained evidence trail. It is not a behavioral fraud-scoring engine, and we won't describe it as one.
Every individual or entity on a case — insured, UBO, beneficiary, broker — runs against OFAC, EU, and UN consolidated lists plus PEP and watchlist data through self-hosted Yente, backed by OpenSanctions. See sanctions and PEP screening.
The provider response, dataset hits, score, and risk level for every screen are retained as tenant-scoped evidence — not just a pass or fail — so a claims or compliance review can see what was checked and when.
Premium and claims bordereaux from brokers are normalized with an AI-suggested column mapping that a human confirms before anything is committed, and validated row by row. See bordereaux processing.
Each tenant workspace runs on its own scoped D1 database inside the Spot Suite customer environment, so a residency question has a specific, checkable answer.
InsureGuardAI does not analyze claims patterns, score claimant behavior, or flag anomalies across a claims portfolio. It screens the parties on a case against sanctions and PEP data and normalizes bordereaux intake. If your control gap is sanctions exposure hiding behind an unscreened counterparty, an unrecorded UBO check, or a bordereaux process with no audit trail, that is the layer this product covers.
Our blog covers the specific ways sanctions and UBO screening breaks in insurance operations — stale re-screening cadence, unrecorded clearances, PEP transitions missed after onboarding. Read it at insureguardai.com/blog.