FraudCheck 360 returns a clear verdict, a trust score, and full evidence in seconds, without a single document leaving Salesforce.
Automated document-fraud detection for insurance, built natively in Salesforce under the Einstein Trust Layer. It turns hours of manual review into seconds, and never auto-rejects a borderline case.
A clear answer in seconds, with the evidence attached.
Built on Salesforce + MuleSoft, inside your own org
Loss estimates, invoices, receipts, proof-of-loss forms, financial statements, and IDs all come from the customer. Altered figures, pasted logos, and re-typed text are hard to catch by eye and getting better. Accept a forgery and you approve a bad claim or policy; reject a genuine one and you lose a good customer. Both mistakes are expensive.
Minutes per document, and reviewers tire and miss details under volume.
Altered amounts and pasted logos increasingly slip past the human eye.
A bad claim, policy, or account approved on false proof is expensive.
Reject a genuine document and you lose a good customer and damage trust.
$308.6B
Estimated annual cost of insurance fraud in the U.S.
Coalition Against Insurance Fraud
48%
Of carriers saw a rise in suspicious claims linked to AI-generated documents
Gallagher Bassett 2026 Carrier Perspective, via Claims Journal
FraudCheck 360 turns hours of manual review into seconds, and never auto-rejects a borderline case.
Upload a document and the system reads it, runs a tailored set of fraud rules plus an AI visual check, and returns a clear answer in seconds. Your team handles far more volume with the same headcount.
Clear cases are decided automatically; only genuinely uncertain ones become Review and go to a person, with the reasons attached. Good customers are never auto-rejected on a borderline case.
Every check, including the AI, runs inside your Salesforce org under the Einstein Trust Layer. No external API calls, no data sharing, and your existing record and field security is honored.
Documents checked in seconds, not minutes, so your team clears far more volume.
A tailored rule set plus AI vision catches figures that don't add up, altered text, pasted logos, and re-typed fonts.
Every verdict carries a trust score, the exact reasons, and a map to the problem on the page.
Each check is saved to the customer record with full evidence and a shareable PDF report.
All AI runs in the Einstein Trust Layer. No external services, no data ever leaves Salesforce.
Rules, point weights, and thresholds are changed by your team in Setup, with no developer needed.
Stand up coverage fast with AI-generated rules, encode the rules your team already trusts, or combine both. The rule set is dynamic, and you adjust either path in Salesforce Setup with no developer.
AI derives the fraud rules from what a genuine document should look like, including branding, figures, expected wording, and visual integrity. You get working coverage quickly, without authoring rules by hand.
Already have fraud criteria, watchlists, or underwriting checks? Encode them directly as configurable rules with your own weights and thresholds, so the system enforces the policies your team already trusts.
MuleSoft Document AI extracts the header, key fields, line items, and totals from the document.
Tests a tailored rule set: branding, figures, wording, dates, and internal consistency.
Inspects the image for pasted logos, font changes between cells, and uneven spacing.
Sets the trust score, applies the verdict, and writes a plain-language reason.
Trust score 85–100
Looks genuine; all checks passed. Accept and continue your normal process.
Trust score 55–84
Borderline, with no clear tampering. A person checks it, with the reasons attached.
Trust score below 55
Clear signs of tampering. Reject or escalate; the evidence is shown.
No new tab, no separate portal. Reviewers get the verdict, evidence, and every rule they can tune — all on the record they already work in.
Every check returns a verdict, a trust score, layered IDP + AI Vision confidence, and a plain-English AI summary — so a reviewer knows exactly why in seconds.
Tune the Authentic, Review, and confidence thresholds, and weight each fraud rule to match your risk appetite — fully transparent, no black box.
The four ROI levers are the same in every insurance line — only the documents, fraud patterns, and numbers change. Pick a vertical to see the case.
Hard-dollar loss savings
Fraudulent or inflated payouts avoided, and leakage recovered, by catching altered documents before money goes out.
Labor & cycle time
Manual review — minutes per document — is replaced by a verdict in seconds, so the same team clears far more volume, faster.
Detection lift
Higher catch rates and fewer misses than the human eye, with a Review tier so good customers are never auto-rejected on a borderline case.
Loss / combined ratio
Because fraud and leakage sit on the loss side, reductions flow directly to loss ratio, combined ratio, or medical loss ratio.
The broadest exposure — every claim, policy, and onboarding runs on customer-supplied documents.
For P&C claims, underwriting, SIU, and risk leadersEstimated annual cost of insurance fraud in the U.S.
Coalition Against Insurance Fraud, 2022
Of insurers report encountering manipulated or AI-altered documents
Verisk State of Insurance Fraud, Mar 2026
About 10% of P&C losses and loss-adjustment expense is attributable to fraud
Insurance Information Institute
Repair estimates and contractor invoices, proof-of-loss statements, medical bills and records, police and incident reports, damage photographs, receipts for lost or stolen property, valuations and appraisals, and government IDs.
Doctored invoices pairing real company names with fabricated line items, padded repair estimates, digitally and AI-altered damage photos, altered amounts on legitimate documents, pasted logos and cloned letterheads, and fictitious or prior-loss claims.
The ROI case — four levers
Fraud is about 10% of losses plus LAE. Catching an altered estimate or fabricated invoice before payout is direct loss avoidance; claims leakage typically runs 5–10% of total claims cost.
Manual review runs 2–4 minutes per document and reviewers tire. An automated read and verdict in seconds lets the same team clear far more volume — IDP benchmarks cite 70–90% review-time savings.
99% of insurers already see AI-altered docs and 76% say they are getting more sophisticated. AI visual forensics catches pixel-level tampering the eye misses.
The 2024 P&C combined ratio was ~97.2% and tightening toward 99% by 2026. Fraud sits on the loss side, so even a partial reduction flows straight to the ratio.
FraudCheck 360 is added on top of your existing org without changing its other apps or automation. All AI reasoning runs inside your org under the Einstein Trust Layer; MuleSoft handles only secure document extraction. No external LLM keys, no data leaves the platform.
All LLM calls route through the Einstein Trust Layer via the Models API and Prompt Builder; MuleSoft IDP extraction is likewise Trust-Layer governed. Rules, weights, and thresholds live in Custom Metadata, tuned in Setup with no deploy.
Document extraction
A CloudHub 2.0 app reads the file via Intelligent Document Processing and returns normalized JSON. Salesforce reaches it through a Named Credential with OAuth, with no secrets in code.
Governed AI
AI Vision (prompt template) and the AI Summary (Models API) run governed, with PII masking, zero retention, toxicity scanning, and audit. The org holds no LLM key and makes no direct external callout.
Resilient by design
If a live AI call can't run, the layer falls back to a deterministic forensic check that still catches tampering. The check never fails outright, and your record and field security is always honored.