RiskStream Collaborative and OPAQUE Partner to Tackle Insurance Fraud with Confidential AI

Insurance fraud is a major industry challenge

With the FBI and National Insurance Crime Bureau (NICB) estimating the total cost of non-health insurance fraud at more than $40 billion per year. Fraudsters often take advantage of the highly fragmented nature of the industry,

knowing that—due to data privacy limitations—individual insurers can typically only analyze their own data rather than pooling and analyzing it to identify potential patterns of fraudulent activity. Because fraudsters use blind spots to carry out criminal activity, exchanging loss incident data between disparate insurers is often mission-critical to successfully identifying and mitigating fraud attempts. 

RiskStream Collaborative, the largest insurance-focused consortium, is on a mission to solve this problem by enabling secure, confidential, AI-powered analytics that detect and prevent fraud. The goal is to unlock cross-carrier insights in complex areas like Workers’ Compensation and Life & Annuities, where data sensitivity is paramount. With members representing some of the nation's largest insurance carriers, RiskStream is uniquely positioned to address this industry-wide challenge.

Focused on workers’ compensation premium fraud and life & annuities provider risk alerts, RiskStream partnered with OPAQUE to create a Confidential AI-powered platform that facilitates encrypted data analysis across multiple insurance carriers to better detect and prevent fraudulent activity—all while upholding strict data privacy and regulatory compliance standards.

When developing this solution, RiskStream needed to build a robust foundation for data exchange that was powerful, secure, and compliant with regulatory requirements. Collaborative members required cryptographic proof that their sensitive data, including premium audits, claims, provider data, and protected health information (PHI), would remain encrypted and confidential when used in collaborative analysis; otherwise, participation would be limited by trust and legal concerns. Traditional tools that rely on anonymization or masking often strip away the key details needed to flag sophisticated fraud, rendering them ineffective.

“If you’re unable to look at any sensitive data at all—even name, or date of birth—it handcuffs your ability to see patterns and flag potential fraud. Improving the amount of data that you have secure access to is incredibly important: if you’re only analyzing your own data, you’re extremely limited in the insights you can get,” explained Eric Phillips, director of product operations at RiskStream Collaborative. 

Existing solutions for data pooling and collaboration—including data masking and anonymization—proved to be time-consuming, inefficient, and even detrimental to the value of the data. RiskStream needed a platform that could ensure data would remain encrypted, protected, and unchanged throughout its entire lifecycle, empowering insurers to harness the benefits of collaborative analysis without modifying existing workflows. At the same time, RiskStream also needed that solution to integrate seamlessly into their systems to maximize efficiency.

“As a collaborative, we had the unique opportunity to help mitigate this existential threat, but we couldn’t do it on our own,” Phillips said. “We needed a solution that would help us securely share data without fears of leakages or breaches.”

Multiple collaborative members recommended OPAQUE, a Confidential AI provider, as the ideal platform to enable secure multiparty analysis while guaranteeing ease of use, ownership, and interoperability.

After extensive evaluation, RiskStream selected OPAQUE as the platform to enable this new paradigm of secure, privacy-preserving fraud detection across multiple insurance lines.

Unlocking secure collaboration across workers' compensation and life insurance

OPAQUE's Confidential AI platform enables RiskStream members to collaborate on fraud detection while maintaining complete data privacy, sovereignty and regulatory compliance.

Through OPAQUE's breakthrough technology, RiskStream members can now tackle fraud across multiple insurance lines:
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Workers' Compensation Premium Fraud: Carriers can now aggregate encrypted premium audit and claims datasets to flag suspicious employer behavior, such as inflated payroll reporting, ghost employees, and duplicate claims—all without exposing sensitive business data to competitors or third parties.
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Life & Annuities Fraud Detection: The platform enables detection of fraud signals during the policy application and claims lifecycle by analyzing patterns across encrypted datasets from multiple carriers. This improves both speed and accuracy of fraud detection while maintaining strict PHI and PII protections.
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The key breakthrough lies in OPAQUE's ability to preserve the full fidelity of sensitive data throughout the analysis process. Unlike traditional anonymization approaches that strip away critical fraud indicators, OPAQUE's confidential AI solution keeps all data encrypted while still enabling sophisticated AI-powered pattern detection.
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By securely leveraging cross-carrier insights, RiskStream members now identify fraud earlier and intervene before financial losses escalate, all while maintaining complete data ownership and control.

Revolutionary technology: Confidential AI + Generative Insights

OPAQUE's platform combines two powerful technologies to unlock previously impossible fraud detection capabilities:

‍Encrypted Data Processing: All carrier data remains fully encrypted before, during, and after analysis inside Trusted Execution Environments (TEEs). This provides cryptographic proof that sensitive information never leaves each carrier's control, addressing both regulatory and competitive concerns.
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Confidential RAG (Retrieval-Augmented Generation): Investigators, auditors, and underwriters can query across encrypted datasets using natural language, retrieving policy-approved results with zero data leakage. This enables intuitive, chat-based interfaces for complex fraud investigations.
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AI-Generated Fraud Detection Reports: Members receive actionable summaries including red flags, anomaly detection results, and employer risk profiles—all generated from encrypted analysis without accessing any raw data from other carriers.
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With these capabilities, carriers can dramatically increase their speed-to-insight, strengthen their Special Investigation Units (SIUs), and maintain confident regulatory compliance throughout the process.

Transforming fraud detection without compromising privacy

The implementation proved a remarkably streamlined turnkey business application. OPAQUE's platform integrated seamlessly with RiskStream's existing infrastructure, enabling data to feed directly into OPAQUE’s platform via existing technology, requiring minimal customization and enabling rapid deployment. And It took only two weeks to set up the platform, enabling RiskStream to avoid laborious and developer-heavy customization.

“OPAQUE’s solution was fairly off the shelf—it only took a little customization,” Phillips explained. “I was extremely impressed. We were on a bit of a time crunch, so to meet that deliverable in such a short amount of time absolutely exceeded our expectations.” 

The platform's user-friendly design empowers RiskStream to serve as the workspace manager, with full control over member access, custom rules, and data governance policies. This ensures security, privacy, and complete trustworthiness between participating carriers.

With OPAQUE, RiskStream members have seen measurable impact across key metrics:

Accelerated fraud detection: Members can now identify red flags earlier and with greater accuracy by leveraging cross-carrier insights that were previously inaccessible.
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Reduced financial exposure: Acting on actionable intelligence before losses escalate has enabled more proactive fraud prevention across multiple insurance lines.
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Improved operational efficiency: Automated generation of fraud summaries and investigative reports directly from encrypted data has streamlined workflows for SIUs, underwriters, and audit teams.
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Maintained full data control: Throughout the entire process, carriers' raw data never leaves their environment, ensuring complete data sovereignty and regulatory compliance.
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The solution has proven particularly valuable for detecting sophisticated fraud schemes that span multiple carriers—patterns that would be impossible to identify through single-carrier analysis alone.

“Our members didn’t even know that this was possible. It was eye-opening to work with OPAQUE and start educating our members on the platform and its capabilities,” according to Phillips.

“OPAQUE is perfectly suited to help solve the problems that insurers face fighting fraud—and they do it in a way that’s secure, private, and verifiable.”

A new standard for collaborative AI in insurance

RiskStream members have been consistently positive about their experience with the OPAQUE platform. Beyond the technical capabilities, they've praised OPAQUE’s responsive customer service and deep expertise in solving complex insurance industry challenges. For RiskStream, OPAQUE is a valued strategic partner, offering thought leadership on evolving challenges like expanding to broader carrier participation and self-hosted LLM deployments.
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The partnership represents more than just a technology deployment—it establishes a new model for how insurance carriers can collaborate on critical industry challenges while maintaining competitive advantages and regulatory compliance.

The future of secure collaboration in insurance

OPAQUE provides the essential AI trust layer that enables insurers to unlock the power of their sensitive data securely, detect fraud faster, and generate compliant AI-driven insights—all without ever exposing proprietary datasets to competitors or external parties.

This breakthrough approach opens new possibilities for industry-wide collaboration on other critical challenges, from climate risk modeling to cyber threat intelligence, establishing a foundation for the next generation of insurance innovation.

“Partnering with OPAQUE shows that the industry can fight fraud together—without compromising data privacy,” said Phillips. “Secure collaboration like this is the future of trusted, data-driven insurance.”

For more information about the RiskStream Collaborative, please visit https://www.riskstream.org, or contact [email protected].