Published:
Jun 02, 2025
Category:
Salesforce Data Cloud
Client location:
United States
Client Overview:
A regional, family-owned insurance company offering auto and home policies partnered with EvoqTech to implement Salesforce Data Cloud for insurance fraud prevention. The company manages $150M in annual premiums and serves 45,000 policyholders across three states. They faced growing losses from fraudulent claims, which threatened profitability and customer trust.
Their claims adjusters relied mostly on manual reviews and intuition. Limited investigative resources allowed repeat offenders and inflated claims to slip through undetected. Disconnected data sources—such as claims history, weather reports, contractor records, and medical providers—further limited their ability to detect fraud and make accurate decisions.
To solve these challenges, EvoqTech implemented Salesforce Data Cloud as a unified fraud detection platform. It integrated multiple data sources and automated risk scoring. This enabled real-time detection of suspicious claims, alerts for repeat claimants, and cross-referencing of claimant data across historical records.
“Connect siloed data, uncover fraud patterns early, and empower adjusters with tools to make faster, fairer claim decisions.”
– Business Needs
Technical Contribution :
Implemented Salesforce Data Cloud to consolidate key fraud-relevant datasets including claims history, contractor records, medical provider info, social security data, and weather verification.
Developed basic risk scoring models to flag potentially fraudulent claims for manual investigation.
Enabled real-time pattern recognition, such as cross-checking claimants, verifying storm damage with weather data, and identifying repeated suspicious behavior.
Created a streamlined fraud investigation dashboard highlighting high-risk cases and automatically compiling documentation for deeper review.
Provided adjusters with a quick-reference tool for claimant history, improving accuracy during initial claim assessments.
Benefits Delivered :
- The solution led to a 65% reduction in fraudulent payouts, saving the insurer $5.2M and detecting 340 suspicious claims in the first year—including three major fraud rings. Investigation speed doubled with a 50% faster review cycle and 30% fewer reopened claims.
- The company also saw a 12% increase in profitability and gained $2.3M in premium growth due to better pricing. Legitimate claim processing was 25% faster, premiums dropped, and customer trust improved thanks to fairer, more transparent claim handling.
