Insurance Investigation Intelligence

Expose insurance fraud with forensic-grade evidence

Intellex Risk Solutions Pvt. Ltd. enables health insurers and TPAs to verify policyholders, validate claims, and uncover fraud through nationwide field investigations and digital analytics.

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Investigation Network

30+

Field Operatives

Turnaround

48h

Preliminary Reports

Coverage

All Odisha

Presence

Success Rate

98%

Case Resolution

Insurance Investigation Services

End-to-end claim, risk, and compliance intelligence for insurers in India

Intellex Risk Solutions blends field operatives, digital forensics, and regulatory expertise to control claim leakage and strengthen underwriting hygiene across the insurance lifecycle.

Insurance Claim Investigation Services

CASE FILE #001

Objective: Verify the legitimacy of insurance claims with evidence-led investigations that safeguard loss ratios and customer trust.

Key Evidence Points

Fraud detection and prevention for false, inflated, or staged claims
Comprehensive financial and lifestyle background checks
Surveillance programs validating disability, injury, or property loss narratives
Structured interviews and witness statements from all involved parties
Scene investigation for accidents, fires, thefts, and catastrophe claims
Document verification covering medical reports, invoices, receipts, and repair estimates

Risk Assessment and Underwriting Analysis

CASE FILE #002

Objective: Evaluate potential risks before policy issuance or renewal through forensic underwriting intelligence.

Key Evidence Points

Pre-insurance surveys for property, fleet, and commercial assets
Loss prevention consultancy with actionable safety roadmaps
Historical claims analytics to benchmark exposure across portfolios

Specialized Insurance Investigations

CASE FILE #003

Objective: Resolve complex or industry-specific claims with niche field expertise and domain specialists.

Key Evidence Points

Motor insurance investigations for accidents, thefts, and third-party liability
Health and medical claims validation with hospital and billing audits
Life insurance investigations covering death verification and beneficiary checks

Legal and Compliance Support

CASE FILE #004

Objective: Deliver defensible documentation and expert evidence for court, arbitration, and regulatory requirements.

Key Evidence Points

Chronology-based evidence documentation for litigation-ready case files
Regulatory compliance checks that keep insurers audit-ready
Expert testimony support for repudiations and dispute resolution

Customer Verification & Background Checks

CASE FILE #005

Objective: Empower insurers with rigorous KYC, AML, and onboarding due diligence to minimise future claim leakage.

Key Evidence Points

Identity verification and address confirmation across India
Criminal record, litigation, and civil dispute screening
Employment, income, and financial health validations for new policyholders

Investigative Workflow

From suspicion to prosecution-ready evidence

Every engagement is governed by rigorous SOPs, medical ethics, and legal compliance to ensure that outcomes withstand regulatory scrutiny.

Step 01

Intelligence Intake

Detailed case intake, fraud hypothesis framing, and digital trace mapping to determine investigative vectors.

Step 02

Field Deployment

Local operatives conduct discreet inquiries, site audits, and subject surveillance aligned with compliance mandates.

Step 03

Medical Corroboration

Doctor panel validates records, tests prescription authenticity, and analyzes treatment pathways for anomalies.

Step 04

Evidence Consolidation

Digital forensics, interview transcripts, and photographic documentation merged into verified evidence packs.

Step 05

Actionable Reporting

Clear liability assessment with fraud risk scoring, legal defensibility notes, and recommendations for insurer action.

Industries Served

Odisha intelligence across critical risk verticals

Intellex operates a vetted investigator network across metro cities, tier-II towns, and remote clusters, ensuring contextual risk insights wherever your customers operate.

Health Insurers

Retail and group health portfolios

TPAs

Managed care and claims administration

Hospitals

Empanelment validation and billing audits

Corporates

Employee wellness and policy compliance

Fitness & Wellness

Lifestyle verification for underwriting

Academic Institutions

Student insurance screening

Case File Spotlight

24-hour bust of a coordinated hospitalization fraud ring

Alerts on unusual room upgrades triggered an Intellex deep-dive. Within 24 hours, field teams uncovered a broker-hospital collusion generating fabricated invoices worth ₹1.2 crore across multiple TPAs.

Key Evidence Points

Covert interviews, CCTV acquisition, and geo-tagged photo evidence validated patient non-admittance.
Consolidated dossier enabled insurers to deny fraudulent claims and initiate regulatory action.

Evidence Matrix

Surveillance hours

Recovered amount

₹1.2 Cr

Regulatory escalations

Assurance Framework

Compliance, security, and clinical rigor at every touchpoint

Our investigative methodologies blend legal defensibility with advanced analytics, enabling insurers to act confidently on high-stakes decisions.

Regulatory Alignment

IRDAI-compliant SOPs, court-admissible documentation, and meticulous chain-of-custody management for every evidence artefact.

Data Security

Secured evidence storage, anonymized reporting to safeguard policyholder data.

Clinical Validation

Independent medical board reviews case notes, prescriptions, and diagnostics to eliminate treatment misrepresentation.

Digital Intelligence

AI-assisted anomaly detection across KYC profiles, IP footprints, and document forensics to fast-track investigation vectors.

Testimonials

Insurers rely on Intellex for investigative certainty

Executive teams, claims desks, and TPAs trust our reports to drive approvals, repudiations, and regulatory escalations with confidence.

Intellex has become our fraud command center. Their field intel and medical corroboration give us confidence to take decisive action on complex claims.

Chief Claims Officer

Leading Health Insurer

Turnaround times are exceptional. We receive concise, investigation-backed reports that hold up in audits and arbitration.

Head of Operations

Odisha TPA

Their compliance-first approach means every report is admissible, defensible, and aligned with regulatory expectations.

Claims Governance Lead

Top 5 Insurer

Ready to investigate

Mobilize Intellex for your next policy or claim review

Our command center equips underwriters, claims officers, and compliance leaders with actionable intelligence within 48 hours.

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