How Insurance Adjusters Can Spot Fraud Before the Payout

Insurance fraud has always been an unfortunate part of the job for adjusters, but today’s bad actors have far more sophisticated tech and tactics at their disposal. It’s part of the reason insurance fraud is costing the U.S. an estimated $308 billion every year. 

Adjusters are trained to look for suspicious claim patterns and inconsistencies in documentation and digital communications, but now they’re targeting the most vulnerable part of the claims process: voice interactions. Without the right training and tools, adjusters are left trying to clock deception based on gut instinct. Learning the red flags and using real-time voice fraud detection can help adjusters stop the con before the check goes out.

What Are The Red Flags?

Insurance adjusters serve as the final line of defense before a claim is approved and payout is issued. That makes them prime targets for fraudsters looking to fast-track false claims or manipulate real ones. 

More insurers are also shifting to customer service and claims processing to call centers and remote adjusters—places where oversight is naturally more lax due to high volume.

Plus, the nature of the job also makes adjusters easy targets. They want to provide good service, comply with time-sensitive escalations, and avoid disputes with customers. Bad actors  know this, and they know tone, urgency, and confidence can go a long way in a phone call. But these fraudsters and scammers  always have their tells, even with deepfakes and voice cloning.

1. Inconsistent or Overly Detailed Stories

Too smooth is a red flag. Fraudsters often memorize a script that sounds convincing—until you ask a follow-up question they weren’t prepared for.

Watch for:

• Exact details volunteered before you ask
• Stumbles or backtracking on basic info
• Overexplaining minor points

Example: A caller gives you an accident timestamp to the second but can’t recall which intersection it happened at.

2. Urgency or Emotional Pressure

Scammers create pressure to override your usual process: “If you don’t help me now, I’ll lose everything!” This one is tricky, because sometimes real policyholders do find themselves in situations like these. But there are still red flags to look out for.

Watch for:

• Sob stories with immediate action needed
• Disproportionate anger, tears, or manipulation
• Pressure to skip verification steps

Example: A caller posing as a grieving spouse begs you to release life insurance funds before the funeral.

3. Requests to Change Payment Details or Beneficiaries

Changing payout info mid-claim is a huge red flag, especially if it comes with a weak excuse or urgent deadline.

Watch for:

• Requests to switch accounts “due to identity theft”
• New beneficiary names not listed on the original policy
• Pressure to update records immediately

Example: “I lost access to my account. Can you wire the payout to this new number instead?”

4. Signs of Voice Manipulation or Pre-Recorded Audio

AI voice tools can mimic real people. Pre-recorded clips can fake a live call. But neither can do so perfectly.

Watch for:

• Unnatural rhythm or timing
• Missing background noise or ambient sounds
• Voice that seems “too perfect” or robotic

Example: The voice is flawless—but you never hear them breathe or use filler words like “um”.

5. Knowledge That’s Just a Little Too Good (Until it Isn’t)

Scammers with access to leaked data or stolen info can name claim numbers, birthdays, or policy types. But dig a little deeper, and they falter.

Watch for:

• Confidence on surface-level info
• Hesitation or evasion on detailed verification
• Answers that mirror what you just said

Example: They know the claim was filed Tuesday but don’t know the insured’s middle name.

6. Calls From Execs

Some scammers pose as internal employees to exploit adjusters’ trust in company hierarchy. These fraudsters count on urgency and perceived authority to override standard checks.

Watch for:

• Calls from names you don’t recognize claiming high-level roles
• Calls from names you do recognize but don’t usually hear from or who are not typically involved with adjustor duties
• Pressure to act quickly “to avoid compliance issues” or “escalation”
• Resistance to standard verification steps (“I don’t have time for that”)

Example: Someone claiming to be from “internal audit” demands immediate payout processing and says they’ll “take it up with your supervisor” if you delay.

Adjusters Deserve (Better) Fraud Detection

Many insurers rely on caller ID, security questions, or voice biometrics to verify identity. But even voice biometrics, a newer technology, was built for a different era. An era without AI voice cloning tools and convincing deepfakes.

Here’s where traditional systems fall short:

• Caller ID is easily spoofed. Fraudsters can make it look like they’re calling from the policyholder’s number or even from inside your organization.
• Knowledge-based authentication is too easy. Questions like “What’s your mother’s maiden name?” are useless when attackers can pull that info from a data breach or a five-minute social media search.
• Voice biometrics can be fooled. AI voice cloning tools are now good enough to mimic a real person’s vocal patterns and pass biometric checks. 
• Most fraud tools are reactive. They work after the damage is done—reviewing logs, analyzing payout trends, or flagging anomalies post-transaction. That’s too late.

What insurers need now is a proactive layer of voice intelligence that works in real time while the fraud is still happening. That’s where VoiceVault comes in.

Real-Time Fraud Detection (and Prevention)

Insurance adjusters are often the first line of defense against fraud, especially during voice-based interactions. But as fraud tactics evolve, so must the tools and strategies used to detect them. Unlike legacy tools that rely on voiceprint comparisons or post-call analysis, VoiceVault’s real-time voice intelligence listens for:

• Deepfake and synthetic voices
• Social engineering and impersonation attempts
• Emotional stress and frustration
• Passive voiceprint verification
• Early signs of cancellation or escalation

It flags potential threats in under 15 seconds so your team can ask follow-ups, pause the process, or escalate, all without changing your customer service scripts or slowing down your workflows. With better training to help adjusters spot red flags in voice communication and real-time voice fraud detection, your team can better stop fraud before it happens, protecting your policyholders and your bottom line.

See How VoiceVault Can Work for You

VoiceVault gives adjusters a new layer of support—one that works in real time, during the call, without disrupting the customer experience. Want to see it in action? Schedule a demo.

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