Services

Comprehensive insurance investigation across the policy lifecycle

Odisha rapid-response investigations deliver evidence-rich intelligence your claims and legal teams can deploy instantly.

Deploy Intellex operatives, med-legal experts, and forensic analysts to expose adverse selection, moral hazard, and organized fraud impacting your health insurance portfolio.

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

Investigation Deliverables

Every assignment culminates in prosecution-ready intelligence

Intellex orchestrates field, digital, and clinical workflows to equip health insurers with decisive documentation that withstands regulatory audits and litigation.

Case Initiation Dossier

Fraud hypothesis, stakeholder mapping, and investigation charter delivered within 6 working hours.

Field Intelligence Pack

Geo-tagged imagery, affidavits, interview recordings, and contextual intelligence from local operatives.

Clinical Review Sheet

Doctor-reviewed treatment analysis comparing claimed procedures against medical best practices and tariffs.

Fraud Risk Scorecard

Weighted scoring across intent, modus operandi, and financial leakage to guide repudiation or settlement strategies.

Stakeholder Briefing

Actionable presentation for claims committees, legal teams, and TPAs with escalation pathways.

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.

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.

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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