保険不正検知市場：保険タイプ、用途、地域別、2026年～2032年

保険不正検知市場の評価、2026年～2032年

損害保険、医療保険、自動車保険、その他各種保険の架空請求を含む保険不正事件の増加が、保険不正検知市場を推進している主な要因です。犯罪者がより賢くなるにつれ、保険会社は詐欺行為を検知・防止する最先端の方法を模索しています。Verified Market Researchのアナリストによると、保険不正検知市場は、2024年には約46億4,000万米ドルの評価額を下回り、予測期間中に235億7,000万米ドルの評価額に達すると推定されています。

虚偽の請求による保険会社の経済的損失の増加が、保険不正検知技術の市場を牽引しています。そのため、独創的な検知戦略の必要性が高まっています。規制当局の要求が高まり、オープン性と効率性に対する消費者の期待が高まる中、保険会社はビッグデータ分析や人工知能のような革新的技術に投資し、不正検知技術の向上に努めています。このような積極的な戦略は、リスクの軽減やコスト削減に役立つだけでなく、保険業界に対する信頼と誠実さを促進します。これにより、市場は2026年から2032年にかけてCAGR 24.85%で成長します。

保険不正検知市場定義/概要

保険不正検知とは、虚偽の保険金請求、誇張された損失、演出された事故、保険証券発行時の情報の虚偽表示など、保険分野における不正行為を検知・防止するプロセスです。人工知能、機械学習、予測分析などの高度なテクノロジーを駆使し、膨大なデータを迅速かつ正確に分析することで、保険会社は不正行為を示唆する動向や異常をリアルタイムで検知することができます。効果的な不正検知システムを導入した保険会社は、財務上の損失を劇的に抑え、保険金請求処理の効率を高め、顧客の信頼を維持することができます。

保険不正検知市場の成長を促す主な要因とは？

保険不正の発生率の増加は、詐欺検出市場の主な促進要因です。保険不正撲滅連合によると、保険不正のコストは米国だけで年間3,086億米ドル以上にのぼります。FBIは、保険不正（健康保険以外）の全費用は毎年400億米ドル以上であり、平均的なアメリカ人世帯の保険料が400～700ドル高くなると考えています。この脅威の増大により、保険会社は高度な詐欺検知システムへの投資を促しています。

不正検知システムにAIや機械学習を活用することで、複雑な不正動向を認識する能力が向上します。ガートナーによると、2025年までに企業向けアプリの75％が、不正検知やその他のセキュリティのユースケースのためにAIや機械学習技術を統合するといいます。このような技術革新は、企業がより効率的で正確なソリューションを求めるにつれて、保険不正検知市場を前進させています。

さらに、規制当局の監視やコンプライアンス要件の高まりが、保険事業者に効果的な不正検知システムの構築を促しています。全米保険委員会連合会（NAIC）によると、48の州、コロンビア特別区、米国バージン諸島がNAIC保険不正防止モデル法に基づく法案を可決し、保険会社に詐欺防止プログラムの実施を義務付けています。不正防止法の普及は、保険事業における高度な不正検知技術の需要を高めています。

保険不正検知市場の需要を左右する課題とは？

旧式の内部不正検知システムは、保険不正検知市場における重要な障害となっています。多くの保険事業者は、旧式のシステムと手作業によるプロセスに依存し続けており、その結果、不正行為の検出において非効率とミスが生じています。こうした旧式のシステムは、リアルタイムのデータ処理に必要な相互接続性を欠いているため、巧妙な詐欺スキームを迅速に検知することができないです。その結果、こうした手法に依存することで、不正検知活動の全体的な有効性が低下し、金銭的損失の危険性が高まる。

さらに、データのプライバシーに関する懸念も、保険不正検知市場の大きな障害となっています。センシティブな個人情報の取り扱いが増加する中、保険事業者は厳しいデータ保護およびプライバシー要件を遵守しなければならないです。保険会社は不正な請求を正確に特定する一方で、自社のシステムが個人情報保護法に違反していないことを確認しなければならないため、こうした規制の遵守が最新の不正検知技術の利用を妨げています。このバランス感覚が、市場の成長性を制限する一方で、斬新なソリューションの採用を遅らせています。

目次

第1章 イントロダクション

• 市場の定義
• 市場セグメンテーション
• 調査手法

第2章 エグゼクティブサマリー

• 主な調査結果
• 市場概要
• 市場ハイライト

第3章 市場概要

• 市場規模と成長の可能性
• 市場動向
• 市場促進要因
• 市場抑制要因
• 市場機会
• ポーターのファイブフォース分析

第4章 保険不正検知市場：保険タイプ別

• 健康保険
• 損害保険
• 生命保険

第5章 保険不正検知市場：用途別

• 保険金詐欺
• 個人情報盗難
• 支払・請求詐欺
• マネーロンダリング
• その他

第6章 地域分析

• 北米
• 米国
• カナダ
• メキシコ
• 欧州
• 英国
• ドイツ
• フランス
• イタリア
• アジア太平洋
• 中国
• 日本
• インド
• オーストラリア
• ラテンアメリカ
• ブラジル
• アルゼンチン
• チリ
• 中東・アフリカ
• 南アフリカ
• サウジアラビア
• アラブ首長国連邦

第7章 市場力学

• 市場促進要因
• 市場抑制要因
• 市場機会
• COVID-19の市場への影響

第8章 競合情勢

• 主要企業
• 市場シェア分析

第9章 企業プロファイル

• SAS Institute
• IBM Corporation
• FICO（Fair Isaac Corporation）
• BAE Systems
• LexisNexis Risk Solutions
• ACI Worldwide
• Fiserv, Inc.
• SAP SE
• Experian plc
• RSA Security LLC
• Verisk Analytics, Inc.
• Shift Technology

第10章 市場の展望と機会

• 新興技術
• 今後の市場動向
• 投資機会

第11章 付録

• 略語リスト
• 出典と参考文献

Insurance Fraud Detection Market Valuation - 2026-2032

The growing number of insurance fraud cases, including fictitious claims for property, health, auto, and other insurance kinds, is the main factor propelling the insurance fraud detection market. As criminals become savvier, insurance companies are looking for cutting-edge ways to detect and prevent fraudulent activity. According to the analyst from Verified Market Research, the insurance fraud detection market is estimated to reach a valuation of USD 23.57 Billion over the forecast subjugating around USD 4.64 Billion valued in 2024.

Increased financial losses to insurers from false claims are driving the market for insurance fraud detection technologies. This has led to a greater need for creative detection strategies. As regulatory demands mount and consumer expectations for openness and efficiency rise, insurance companies are investing in innovative technologies like big data analytics and artificial intelligence to improve their fraud detection skills. This proactive strategy not only helps to mitigate risks and save costs, but it also promotes confidence and integrity in the insurance industry. It enables the market to grow at a CAGR of 24.85% from 2026 to 2032.

Insurance Fraud Detection Market: Definition/ Overview

Insurance fraud detection is the process of detecting and preventing fraudulent activity in the insurance sector, such as false claims, exaggerated losses, staged accidents, and misrepresentation of information during policy issuance. It entails the use of advanced technologies such as artificial intelligence, machine learning, and predictive analytics to rapidly and correctly analyze massive volumes of data, allowing insurers to detect trends and anomalies suggestive of fraudulent conduct in real time. Insurance businesses that deploy effective fraud detection systems can dramatically minimize financial losses, enhance claim processing efficiency, and maintain client trust.

What are the Key Factors Driving the Growth of the Insurance Fraud Detection Market?

The increased incidence of insurance fraud is a major driver of the fraud detection market. According to the Coalition Against Insurance Fraud, insurance fraud costs more than $308.6 billion a year in the United States alone. The FBI believes that the entire cost of insurance fraud (non-health insurance) is more than USD 40 Billion each year, costing the average American household between $400 and $700 in higher premiums. This increased threat is prompting insurers to invest in advanced fraud detection systems.

The use of AI and machine learning in fraud detection systems improves the ability to recognize complicated fraud trends. According to Gartner, by 2025, 75% of enterprise apps will integrate AI and machine learning technology for fraud detection and other security use cases. This technological innovation is propelling the insurance fraud detection market forward as businesses seek more efficient and accurate solutions.

Furthermore, the increasing regulatory scrutiny and compliance requirements are prompting insurance businesses to build effective fraud detection systems. The National Association of Insurance Commissioners (NAIC) says that 48 states, the District of Columbia, and the United States Virgin Islands have passed legislation based on the NAIC Insurance Fraud Prevention Model Act, which mandates insurers to implement anti-fraud programs. The widespread adoption of anti-fraud laws is driving up demand for advanced fraud detection technologies in the insurance business.

What are the Challenges Influencing the Demand for Insurance Fraud Detection Market?

Outdated internal fraud detection systems are a key impediment in the insurance fraud detection market. Many insurance businesses continue to rely on antiquated systems and manual processes, resulting in inefficiencies and mistakes in detecting fraudulent activities. These antiquated systems lack the interconnectivity required for real-time data processing, making it impossible to detect sophisticated fraud schemes quickly. As a result, dependence on these methods reduces the overall effectiveness of fraud detection efforts and raises the danger of financial losses.

Furthermore, data privacy concerns are another major impediment to the insurance fraud detection market. With the increased processing of sensitive personal information, insurance businesses must adhere to severe data protection and privacy requirements. Compliance with these restrictions hampers the use of modern fraud detection technology, as insurers must verify that their systems do not breach privacy laws while accurately identifying fraudulent claims. This balancing act slows the adoption of novel solutions while limiting the market's growth potential.

Category-Wise Acumens

How Does the High Incidence of Fraudulent Claims Drive the Detection of Health Insurance?

According to VMR analysis, the health insurance segment is estimated to dominate the market during the forecast period. The high rate of false claims linked with health insurance is one of the factors driving this dominance. Given the complexities of medical billing and the possibility of overstated claims, health insurers face considerable problems in detecting fraud. This has boosted the demand for sophisticated fraud detection technologies capable of analyzing medical records and billing data to find anomalies and prevent losses.

Governments and regulatory agencies are enforcing stronger requirements to combat healthcare fraud, requiring insurers to use advanced fraud detection systems. Compliance with these requirements not only helps to mitigate risks but also improves health insurers' overall operational efficiency, which drives up demand for fraud detection systems.

Furthermore, the growing usage of technology in the healthcare business is critical to the expansion of the health insurance fraud detection market. The combination of artificial intelligence, machine learning, and big data analytics allows insurers to process large volumes of data quickly and reliably. This technical development enables real-time monitoring and analysis, considerably increasing the ability to detect and prevent fraudulent activity in health insurance claims.

How does Claims Fraud Account Significant Part of the Insurance Fraud Detection Market?

The claims fraud segment is estimated to dominate the insurance fraud detection market during the forecast period. The rise in the number of false claims is a major reason for the claims fraud segment's growth. As insurance fraud becomes increasingly complex, insurers are under increasing pressure to improve their detection skills. This urgency drives increased investment in new technologies and analytics for detecting and mitigating fraudulent claims, guaranteeing financial stability, and protecting honest policyholders.

Technological improvements in data analytics and machine learning have considerably boosted the claims fraud segment. These technologies allow insurers to swiftly evaluate massive volumes of data, detecting trends and abnormalities that suggest probable fraud. As insurers employ more sophisticated detection systems, their capacity to quickly handle and evaluate claims improves, cementing the claims fraud segment's market leadership.

Furthermore, regulatory concerns and the requirement for compliance contribute to the claims fraud segment's prevalence. To comply with regulatory requirements and avoid penalties, insurers must increasingly demonstrate sophisticated fraud detection measures. This legal climate forces businesses to prioritize claims fraud detection, resulting in increasing investments in solutions that can successfully identify and resolve false claims, strengthening the segment's market position.

Country/Region-wise Acumens

How Does the High Incidence of Insurance Fraud Cases in North America Influence the Market?

According to VMR analyst, North America is estimated to dominate the insurance fraud detection market during the forecast period. North America, particularly the United States, experiences a high rate of insurance fraud, necessitating the development of improved detection technologies. According to the Coalition Against Insurance Fraud, insurance fraud costs Americans at least USD 308.6 Billion every year. The National Insurance Crime Bureau (NICB) finds that suspicious claims grew by 26.7% between 2017 and 2019. Due to the high occurrence of fraud incidents, regional insurance companies are investing extensively in fraud detection systems.

Furthermore, the regulatory landscape in North America, particularly in the United States, is requiring insurance companies to build robust fraud detection systems. According to the National Association of Insurance Commissioners (NAIC), 48 states in the United States have passed anti-fraud legislation based on the NAIC's model fraud statute. Also, the Insurance Information Institute notes that 42 states, including the District of Columbia, have established fraud bureaus to detect and prosecute insurance fraud. This regulatory pressure is a major driving force behind the deployment of advanced fraud detection technology in the North American market.

What are the Main Drivers of the Market in the Asia Pacific Region?

The Asia Pacific region is estimated to exhibit the highest growth within the insurance fraud detection market during the forecast period. The Asia Pacific region's insurance business is rapidly expanding, increasing the demand for fraud detection technologies. According to a Swiss Re Institute analysis, rising Asian insurance markets are predicted to increase by 8.5% by 2024, exceeding the global average. China, the region's largest market, saw insurance premiums rise by 4.7% in 2021, totaling USD 700 billion. The fast expansion of the insurance sector increases the risk of fraud, generating the need for improved detection technologies.

Furthermore, the expansion of digital insurance platforms in the Asia Pacific opens up new opportunities for fraud, needing more advanced detection systems. According to a Bain & Company analysis, digital insurance penetration in Southeast Asia is expected to increase to 11% by 2025, from 1.5% in 2019. According to the China Banking and Insurance Regulatory Commission, internet insurance premiums increased by 13.9% year on year in 2020, reaching RMB 298 billion (about USD 46 billion). This digital shift is driving insurers to invest in AI-powered fraud detection systems to address increasing cyber fraud threats.

Competitive Landscape

The competitive landscape of the insurance fraud detection market is characterized by a dynamic interplay between established players and rising startups, both of which strive to innovate and improve fraud detection skills. Companies are rapidly using modern technologies like artificial intelligence, machine learning, and big data analytics to improve their fraud detection systems, resulting in more effective identification and prevention of fraudulent activity.

Some of the prominent players operating in the insurance fraud detection market include:

SAS Institute

IBM Corporation

FICO

BAE Systems

LexisNexis Risk Solutions

ACI Worldwide

Fiserv, Inc.

SAP SE

Experian plc

RSA Security LLC

Verisk Analytics, Inc.

Shift Technology

Insurance Fraud Detection Latest Developments:

In May 2023, Verisk, a provider of insurance data analytics, partnered with CCC Intelligent Solutions, a cloud platform serving the property and casualty (P&C) insurance market. This collaboration aims to enhance insurance fraud risk management by integrating Verisk's claims fraud detection analytics with CCC's claims platform.

In March 2023, Shift Technology, a global provider of AI-driven decision automation solutions for insurers, expanded its partnership with the General Insurance Association of Singapore (GIA). This expansion involves extending the use of Shift Claims Fraud Detection to include travel insurance fraud detection. The initiative builds upon the success of GIA's Fraud Management System (FMS) and aims to enhance fraud detection capabilities across the sector. This collaboration enables GIA member insurers to effectively detect and manage fraudulent claims, particularly within the growing global travel insurance segment.

Insurance Fraud Detection Market, By Category

• Insurance Type:
• Health
• Property & Casualty
• Life Insurance
• Application:
• Claims Fraud
• Identity Theft
• Payment and Billing Fraud
• Money Laundering
• Others
• Region:
• North America
• Europe
• Asia-Pacific
• South America
• Middle East & Africa

TABLE OF CONTENTS

1. INTRODUCTION

• Market Definition
• Market Segmentation
• Research Methodology

2. Executive Summary

• Key Findings
• Market Overview
• Market Highlights

3. Market Overview

• Market Size and Growth Potential
• Market Trends
• Market Drivers
• Market Restraints
• Market Opportunities
• Porter's Five Forces Analysis

4. Insurance Fraud Detection Market, By Insurance Type

• Health
• Property and Casualty
• Life Insurance

5. Insurance Fraud Detection Market, By Application:

• Claims Fraud
• Identity Theft
• Payment and Billing Fraud
• Money Laundering
• Others

6. Regional Analysis

• North America
• United States
• Canada
• Mexico
• Europe
• United Kingdom
• Germany
• France
• Italy
• Asia-Pacific
• China
• Japan
• India
• Australia
• Latin America
• Brazil
• Argentina
• Chile
• Middle East and Africa
• South Africa
• Saudi Arabia
• UAE

7. Market Dynamics

• Market Drivers
• Market Restraints
• Market Opportunities
• Impact of COVID-19 on the Market

8. Competitive Landscape

• Key Players
• Market Share Analysis

9. Company Profiles

• SAS Institute
• IBM Corporation
• FICO (Fair Isaac Corporation)
• BAE Systems
• LexisNexis Risk Solutions
• ACI Worldwide
• Fiserv, Inc.
• SAP SE
• Experian plc
• RSA Security LLC
• Verisk Analytics, Inc.
• Shift Technology

10. Market Outlook and Opportunities

• Emerging Technologies
• Future Market Trends
• Investment Opportunities

11. Appendix

• List of Abbreviations
• Sources and References