Momentum’s Head of Claims on Using AI to Stop Insurance Fraud

Insurance fraud continues to challenge South Africa’s short-term sector, eroding consumer trust and inflating premiums for honest policyholders. As the industry accelerates its digital transformation, artificial intelligence (AI) is emerging as a critical tool in the fight against increasingly sophisticated fraud.

“Short-term insurance landscape is undergoing a definite shift,” says Funeka Ngewu, Head of Claims at Momentum Insure. “Fraud is no longer limited to isolated incidents; it has become syndicated and institutionalised. Fraudsters now leverage advanced technology, including AI and deepfake capabilities, to create highly convincing fake claims. This shift highlights the need to proactively enhance our defence mechanisms.”

"To stay ahead, the industry must deploy AI within fraud models to detect anomalies faster and across the entire claims value chain. Effective fraud models are no longer 'plug-and-play' systems” Ngewu explains. “They must be continually scrutinised to ensure ethical outputs, fairness, and compliance with evolving legislation.”

AI offers a solution far more robust than traditional rule-based systems. By combining machine learning algorithms with vast, complex datasets including claims history, policy data, customer behaviour, and communication records; AI can detect subtle anomalies and predictive indicators of fraud that human assessors might miss. In the South African context, where organised syndicates pose a significant threat, this real-time, sophisticated analysis is crucial for shifting from reactive investigation to proactive prevention.

Yet Ngewu emphasizes that technology cannot replace the human side of insurance. “the core of insurance remains a human promise,” she notes. “It’s about providing financial security and emotional support during times of crisis and AI can serve this purpose, not replace it. While AI can streamline routine and low-complexity claims, a human touch remains essential for traumatic events like severe accidents or property damage caused by extreme weather. When clients suffer a loss, they first need to be treated with empathy and kindness before technical details are addressed. This human interaction provides necessary comfort and is a key differentiator in customer experience.”

Momentum Insure is operationalising AI at the heart of its claims process to enhance accuracy, detect sophisticated fraud, and create a fairer, faster experience. “Our AI-driven models perform several key functions including scoring claims for suspicious activity by comparing current data points against historical patterns of fraudulent and legitimate claims,” explains Ngewu. “This instantly highlights "red flag" cases, allowing for timely human investigation.”

AI also helps identify digitally manipulated evidence, analysing photos for inconsistencies in metadata, lighting, or object placement to detect fakes. But responsible deployment is key. Momentum Insure has implemented ethical oversight protocols, regularly auditing algorithms for bias and ensuring human assessors remain central to fair decision-making.

By automating low-risk workflows, claims experts are freed to focus on complex cases and provide high-touch service to clients who need it most. “AI empowers our teams to make smarter, faster, and fairer decisions,” says Ngewu. “It protects policyholders, strengthens the credibility of the insurance sector, and ultimately helps keep premiums fair for everyone.”

As fraud in South Africa becomes more technologically sophisticated, AI is not just a tool; it’s a strategic necessity. And when paired with human expertise, it positions insurers to fight fraud effectively while maintaining the trust and confidence of their clients.