Insurance Fraud Investigation

Help Claims Fraud Investigators better identify and quantify claim fraud with the power of AI and ML.


EIS Group



App Type

Enterprise Application


2022 - present


Lead Designer


Product Design
Web Design
0 to 1
Design Sprint
User Research
Usability Testing
Design System



In 2022, EIS Group (formerly Metromile Enterprise) pursued the next evolution of its insurance Fraud Detection Application. Through conversations with new and existing customers, an opportunity arose for a new app that could not only identify fraud, but allow for investigation as well.


Over the course of several weeks, we designed a new Fraud Investigation Application. This new product incorporates Artificial Intelligence and Machine Learning to help insurance carriers identify potentially fraudulent claims, investigate those claims, and document evidence.


Currently in contract ($10MM over 5 years ARR)

My Role

I was the Design Lead responsible for the product design and user experience. Additionally, I conducted customer research, ran usability tests, and facilitated feedback sessions with existing and prospective customers.

Business Problems

Our Target Buyers are the Claims Organizations in Insurance Carriers. These organizations are typically trying to solve the following problems by identifying fraudulent claims and preventing fraudulent payouts.

  • Fraud Increases Cost per Claim

    Money paid out to claims that are fraudulent increases overall costs due to payouts that aren't accurate and the time spent to payout someone you shouldn't.

  • Fraud Increases Claim Duration

    Fraudulent claims, and investigation fraudulent claims, takes time for the team to investigate, thus taking away man-hours that could be spent helping real customers.

  • Investigating Fraud Causes Poor NPS

    Investigating a claim for fraud when it doesn’t exist adds more time between them reporting the claim and sending a payment, creating a terrible customer experience.


I synthesized roles and responsibilities found in Claims Organizations into three archetypes.

Avatar for the gatekeeper
Avatar for the investigator
Avatar for the manager

User Problems

When speaking with customers and prospects, the following items surfaced as consistent challenges across all roles and organizations, regardless of scope and scale.

  • Fraud is Hard to Spot

    Understanding where the risks are in a claim relies on human experience and is not aided by many tools today. Additionally, there is a lack of visibility to understand changes in a claim over time.

  • Redundant & Repetitive Tasks

    Many tasks at the start and end of investigation are the same amongst all investigations and involve running the same reports, uploading the same reports for each respective case, and updating internal and external systems when the investigation is concluded.

  • Systems Aren’t Well Connected

    Getting data in and out of applications is an incredibly tedious process today. It usually involves some form of manual download and upload between local files and various online web portals.



Design System



Link to Figma prototype
All design and engineering tickets are currently on hold due to contract negotiations with one of our late stage prospects. However, you can view the prototype here.